Pure Laparoscopic Versus Open Right Hepatectomy in Live Liver Donors

Abstract

The aim of the study was to present the safety and feasibility of pure laparoscopic donor right hepatectomy (PLDRH) in comparison with those of conventional donor right hepatectomy. Summary Background Data: Although the use of PLDRH is gradually spreading worldwide, its outcomes, including the long-term outcomes in both donors and recipients, have not yet been evaluated in a large comparative study. Methods: We retrospectively reviewed the medical records of 894 donors who underwent living donor liver transplantation between January 2010 and September 2018 at Seoul National University Hospital. We performed 1:1 propensity score matching between the PLDRH and conventional donor right hepatectomy groups. Subsequently, 198 donor-recipient pairs were included in each group. Results: The total operation time (P < 0.001), time to remove the liver (P < 0.001), and warm ischemic time (P < 0.001) were longer in the PLDRH group. None of the donors required intraoperative transfusion or experienced any irreversible disabilities or mortalities. The length of postoperative hospital stay was significantly shorter in the PLDRH group (P < 0.001). The rate of complications in donors was similar between the 2 groups. Although other complication rates in recipients were, however, similar, the rates of early (P ¼ 0.019) and late (P < 0.001) biliary complications in recipients were higher in the PLDRH group. There was no significant difference in overall survival and graft survival between the 2 groups. Conclusions: PLDRH is feasible when performed at an experienced living donor liver transplantation center. Further studies on long-term recipient outcomes including biliary complications are needed to confirm the safety.

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time

“…In addition, an effective surgical technique has been suggested for various anatomical variations in PLDRH after overcoming the learning curve (13)(14)(15). However, additional studies on the recipient's biliary complications and long-term outcomes are required (6,7). The quality of the graft in LDLT is vital.…”

“…There have been several studies on pure laparoscopic donor hepatectomy (PLDH) at specialized medical institutions (3)(4)(5). In particular, pure laparoscopic donor right hepatectomy (PLDRH) has shown no significant differences in donor safety and feasibility, as well as overall and graft survival of recipients, compared to conventional donor right hepatectomy (CDRH) (6)(7)(8). Recently, MIDH, particularly involving pure laparoscopic techniques, is now accepted by international expert consensus guidelines.…”

Pure Laparoscopic Donor Hepatectomy: A Multicenter Experience

“…There are several ways to reduce biliary complications. This includes the selection of donors with favorable biliary anatomy; minimizing hilar dissection and the usage of energy devices that can injure the bile duct; a reduction in warm ischemia time (35) ; division of the optimal bile duct point using intraoperative cholangiography, sonography, or real-time indocyanine green near-infrared fluorescence depending on the center's preference; and the consideration of external biliary drainage.…”

Laparoscopic liver resection: indications, limitations, and economic aspects

“…This underlines the importance of a previous study reporting on a higher percentage of multiple bile duct openings in PLDRH [76]. With regard to the course of the recipient, it seems noteworthy that time to remove the liver and warm ischemic time are usually longer after PLDRH compared with open right hepatectomy [77]. This is clinically significant because the longer ischemic time must be blamed, at least in parts, for the higher rate of biliary complications after PLDRH [77].…”

“…With regard to the course of the recipient, it seems noteworthy that time to remove the liver and warm ischemic time are usually longer after PLDRH compared with open right hepatectomy [77]. This is clinically significant because the longer ischemic time must be blamed, at least in parts, for the higher rate of biliary complications after PLDRH [77]. A final evaluation of this technique is not yet possible based on the available data and PLDRH remains controversial due to safety concerns both in the donor and in the recipient.…”