Minimally Invasive Living Donor Right Hepatectomy: Initial Experience in a Southeast Asian Transplant Center

Abstract

Introduction: While laparoscopic left lateral sectionectomy is increasingly adopted in pediatric donors, laparoscopic donor right hepatectomy (LDRH) is only performed in a small number of highly experienced centers. We report our initial experience with LDRH as a medium-sized liver transplant center. Methods: Retrospective analysis of living donor adult liver transplantations (LDLT) between January 2018 and December 2019 was conducted. A total of 25 LDLTs were performed, of which 7 were LDRH. Patients with anatomical variation seen on pre-operative imaging were excluded from LDRH. All cases performed were without the middle hepatic vein. Results: Amongst LDRH cases, 3 (42.9%) were performed via laparoscopic-assist while the remaining cases (57.1%) were pure LDRH. There were 4 males (57.1%) in this group, and the median age was 41 years old (29-53 years old). Most patients (57.1%) had a body mass index of less than 25kg/m2. Median graft volume was 798mls (622-1115mls), while the median total liver volume was 1364mls (949-1728mls). Median operative time was 435 minutes (391-592 minutes) and estimated median blood loss was 300 mls (150-900 mls). The first two cases in this series were planned conversions, while the other was due to short hepatic vein bleeding. There were no post-operative morbidity and mortality reported and all patients were discharged within the first week after surgery (4-7 days). Conclusion: LDRH is safe and feasible in a medium-sized liver transplant center. Careful case selection and planned conversions can mitigate the initial steep learning curve. Larger sample size and long-term follow up data is required.