Laparoscopic vs Open Living Donor Right Hepatectomy for Adult Liver Transplantation – Experience from a South East Asian Centre

Abstract

Introduction: Laparoscopic donor left lateral sectionectomy has become the standard of care but laparoscopic donor right hepatectomy (LDRH) remains as an “innovative procedure” in the Second Morioka international consensus. The current study aims to compare the short-term outcomes between LDRH and open donor right hepatectomy (ODRH). Methods: Eight consecutive LDRH surgeries were performed between October 2018 to June 2019, of which 4 were laparoscopic-assisted (LARH) while the rest were performed fully laparoscopically (FLDRH). Their outcomes were compared with that of 28 consecutive ODRH performed between January 2016 to September 2019. Results: The median operative time (418 vs 430 mins; p=0.939) and blood loss (300 vs 350 mLs; p=0.985) were similar. There was no significant difference in the number of days prior to initiation of soft diet (2 vs 2 days; p=0.198), bowel movement (5 vs 4; p=0.717) and return to normal activities (55 vs 48 days; p=0.970). LDRH patients ambulated earlier (1 vs 2 days; p=0.012), had shorter length of stay (5 vs 6 days; p=0.034) and lower incidence of wound related morbidity (0.0% vs 39.3%; p=0.076). Conclusion: Laparoscopic surgery appears promising for donor right hepatectomies in light of better cosmesis, and possibly faster post-operative recovery with a comparable perioperative safety profile. However the sharp learning curve mandates a systematic gradual increase in laparoscopic case complexity to maintain donor safety while mounting the learning curve, especially in small – medium volume centres.