Standardized hybrid living donor hemihepatectomy in adult‐to‐adult living donor liver transplantation

Abstract

The aim of this study was to analyze the outcomes of the most updated version and largest group of our standardized hybrid (laparoscopic mobilization and hepatectomy through midline incision) living donor (LD) hemihepatectomy compared with those from a conventional laparotomy in adult-to-adult living donor liver transplantation (LDLT). Of 237 adult-to-adult LDLTs from August 1997 to March 2017, 110 LDs underwent the hybrid procedure. Preoperative and operative factors were analyzed and compared with conventional laparotomy (n = 126). The median duration of laparoscopic usage was 26 minutes in the hybrid group. Although there was improvement in applying this procedure over time from the beginning of the series of cases studied, blood loss and operative duration were still smaller and shorter in the hybrid group. There was no significant difference between the groups in the incidence of postoperative complications greater than or equal to Clavien-Dindo class III. There was no difference in recipient outcome between the groups. Our standardized procedure of hybrid LD hepatectomy is applicable and safe for all types of LD hepatectomies, and it enables the benefit of both the laparoscopic and the open approach in a transplant center without a laparoscopic expert. Liver Transplantation 24 363-368 2018 AASLD.

Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation

“…A report from Kitajima et al, which included 35 cases of hybrid left hepatectomy, described lower operative blood loss, a longer duration of operation, and a lower incidence of postoperative scar discomfort or tightness . Another relatively large comparative study including 66 cases of hybrid left hepatectomy showed lower blood loss with similar incidence of postoperative complications for donor and recipient survival outcomes . In this study, the authors mentioned that the hybrid technique could be a good option for donor hepatectomy in centers where the pure laparoscopic technique could not be applied due to technical difficulties or medical insurance problems while combining the benefit of both the laparoscopic and open approaches .…”

“…(33) Another relatively large comparative study including 66 cases of hybrid left hepatectomy showed lower blood loss with similar incidence of postoperative complications for donor and recipient survival outcomes. (34) In this study, the authors mentioned that the hybrid technique could be a good option for donor hepatectomy in centers where the pure laparoscopic technique could not be applied due to technical difficulties or medical insurance problems while combining the benefit of both the laparoscopic and open approaches. (33,34) Another study compared the perioperative outcomes between a hybrid donor hepatectomy and PLDH including 14 cases of left hepatectomy in the hybrid group and 9 cases of left hepatectomy in the PLDH group.…”

“…Although not on the pure laparoscopic method, there are several reports on the feasibility and safety of hybrid laparoscopic donor hepatectomy compared with the open technique . A report from Kitajima et al, which included 35 cases of hybrid left hepatectomy, described lower operative blood loss, a longer duration of operation, and a lower incidence of postoperative scar discomfort or tightness .…”

“…Some donors who underwent open donor hepatectomy were known to report the complaint about abdominal bloating, loss of muscle tone, poor body image, and fatigue. ( (33,34) A report from Kitajima et al, which included 35 cases of hybrid left hepatectomy, described lower operative blood loss, a longer duration of operation, and a lower incidence of postoperative scar discomfort or tightness. (33) Another relatively large comparative study including 66 cases of hybrid left hepatectomy showed lower blood loss with similar incidence of postoperative complications for donor and recipient survival outcomes.…”

Laparoscopic donor hepatectomy

“…It may also improve donor outcomes with regard to postoperative pain, reduced length of stay, quality of life, and body image . A step‐by‐step adoption of LADH is advisable to allow team members to master the necessary skills in laparoscopic mobilization, hilum dissection, and parenchymal transection through relatively compromised surgical exposure during the learning curve .…”