Surgical Tips of Pure Laparoscopic Living-Donor Hepatectomy for Donors with Right Portal Vein Anatomical Variations

Abstract

Introduction: Most centers apply strict selection criteria for pure laparoscopic adult living donor hepatectomy. Donors with anatomical variations are considered contra-indication for this procedure.We describe our standardized procedure for safe pure laparoscopic adult living donor hepatectomy for donors with right portal vein (RPV) variations, and present their peri-operative outcomes. Method: We reviewed the data of adult living donors with RPV anatomical variations who underwent pure laparoscopic donor hepatectomy between August 2016 and October 2018. Result: During the study period, 15 donors with RPV variations underwent pure laparoscopic living donor right hemi-hepatectomy. 4 donors (26.7%) had type II portal vein, 7 donors (46.7%) had type III portal vein, and 4 donors (26.7%) had type IV portal vein. Multiple right hepatic ducts were encountered in 13 donors (86.7%). No open conversions or peri-operative blood transfusion were required. Post-operative morbidity occurred in one donor (6.7%), in the form of cystitis. No postoperative biliary or vascular complications occurred. No readmissions were required during the follow up. Conclusion: The current series proves the safety and feasibility of laparoscopic approach for donors with RPV variations. This series is a step towards further expansion of the current indications of laparoscopic adult living donor hepatectomy.