Initial Experience of 60 Cases Pure-Laparoscopic Donor Hepatectomy in Cleveland Clinic

Abstract

Introduction: The adoption of pure-laparoscopic donor hepatectomy (PLDH) has been slow in North America because of the associated technical complexity and concerns for donor safety. This study aimed to report our initial 60 PLDH and elaborate on the understanding of the pre-requisites for the successful introduction of PLDH. Method: Retrospective review during the initial 2 years after the introduction Results: Between August 2019 and August 2021, 60 PLDH were performed; 33 patients donated left lobe grafts, 25 cases were right lobe grafts, 1 case was right posterior section graft, and 1 patient donated left lateral segment. The characteristics of 60 PLDH were summarized in Table. The median operative time was 345 minutes in the left lobe group and 348 minutes in the right lobe group, respectively. No cases required intraoperative blood transfusion or open conversion. Two patients developed a postoperative surgical wound infection, one patient required postoperative blood transfusion, one patient required laparoscopic portal vein venoplasty for portal vein stenosis. The median in-patient stay was 5 days (4-9) and there were no 30-day readmissions. Conclusions: Seamless introduction of OLDH and donor safety were achieved by: 1) minimizing the learning curve through proctorship from experienced surgeon, 2) establish a dedicated surgical team and accumulate adequate surgical experience in living donor hepatectomy and laparoscopic hepatectomy, especially major hepatectomy, 3) active institutional support to have proper instrumentation necessary for operational efficiency, and 4) proper master planning including the ready availability of a crisis management protocol and team in case of an emergency.Tabled 1Left Lobe (N=33, 55.0%)Right lobe (N=25, 41.7%)Age34 (18-58)43 (25-58)male/Female22/117/18Height178 (158-196)168 (155-189)Weight82 (61-119)76 (54-122)BMI27.6 (21.3-36.6)27.7 (21.3-39.7)Operative time345 (256-501)348 (264-450)EBL200 (50-600)150 (30-500)Complicatio33LOS5 (4-8)5 (4-9) Open table in a new tab