Pure laparoscopic living donor left lateral sectionectomy in pediatric transplantation: First case in Western India

Abstract

Pure laparoscopic left lateral sectionectomy (LLS) is fast becoming the standard technique for donor hepatectomy in pediatric liver transplantation. We present the first case of pure laparoscopic LLS performed in Western India. An 11-month-old male child suffering from biliary atresia with history of failed Kasai operation at the age of 3 months presented to our center in Mumbai for a living donor liver transplantation. The donor was his father, 32-year-old with body mass index of 22, LAI +10 and MRE fat fraction of 1%-3%. Projected graft weight of LLS was 187 grams with GRWR of 2.4. He had favorable vascular and biliary anatomy with left hepatic artery (LHA) arising from hepatic artery proper and segment 4 artery from LHA, type A portal vein and A1B1 biliary anatomy. Patient underwent pure laparoscopic LLS. The technique of pure laparoscopic LLS is demonstrated in the attached video. The graft warm ischemic time was 7 minutes, blood loss 300 mL and operating time 7 hours. The donor was discharged on 5th post-operative day with a minor post-operative bile leak that resolved spontaneously and is well at 1 month follow-up. Pure laparoscopic living donor LLS is safe and should be performed by a team experienced in open donor hepatectomy, advanced laparoscopic surgery after specific training in the procedure and negotiating the learning curve under supervision. The operative time was long, but consistent with worldwide data for early cases, which we anticipate will reduce with more experience.