Clinical Outcomes of Totally Laparoscopic Living Donor Right Hepatectomy

Abstract

Initial concerns regarding healthy donor’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation (LDLT) have delayed the development of laparoscopic donor hepatectomy in adult-to-adult LDLT. However, decreased blood loss, less postoperative pain, shorter length of stay in hospital, and excellent cosmetic outcome have well been validated as the advantage of laparoscopic hepatectomy. Hence, the safety and feasibility for laparoscopic donor should be further investigated. We report initial experiences and adequate inclusion criteria for totally laparoscopic living donor right hepatectomy. Totally laparoscopic living donor right hepatectomy in 13 cases were performed from May 2016 up to April 2017. For this procedure, the donors’ right portal vein with long segment of more than 5 mm were preferentially included. However, the bile duct anomaly was preoperatively evaluated with magnetic resonance cholangiopancreatography (MRCP) and was not excluded for totally laparoscopic approach. The 1st case used 2D conventional rigid 30° rigid laparoscopic system and the next 12 cases used 3D flexible laparoscopic system. In 8 cases, hepatic duct anomalies (Type 2, 3a, 3b) were identified. Mean operation time was about 463 min and the warm ischemic time was within 15 minutes. During operation, there was no transfusion and the inflow control like Pringle maneuver was not used at all. V5 or V8 were reconstructed in 12 cases and large right inferior hepatic vein was prepared for anastomosis in 6 cases. All grafts were removed through the supra-pubic transverse incision. The donors were discharged at mean 7 days after hepatectomy. Bile leakage was identified in only 1 case and resolved after the biliary stent insertion by ERCP. During the short-term follow-up period in the donors except this case, complications were not confirmed. Conclusively, totally laparoscopic right donor hepatectomy in adult-to-adult LDLT can be initially attempted after enough experiences of laparoscopic hepatectomy and LDLT. However, the true benefits of totally laparoscopic living donor right hepatectomy should be fully assessed through various experiences from multi-institutes.