Laparoscopic Donor Hepatectomy Research Articles

Postoperative Health Status and Quality of Life after Pure Laparoscopic Donor Hepatectomy for Living Donor Liver Transplantation: Post-operative Recovery and Outcomes of Laparoscopic versus Open Hemihepatectomy in Donors (POROLOH-D)

Background: Surgical outcomes of laparoscopic donor hepatectomy (LDH) have shown comparable results to open donor hepatectomy (ODH), but the quality of life (QOL) after LDH is not known. The prospective questionnaire-based study was perfumed to compare QOL of LDH versus ODH donors.

Early Experience of Pure Robotic Right Hepatectomy for Liver Donors in a Small-Volume Center.

Living donor right hepatectomy has become the most common method of liver transplantation. With minimally invasive surgery, laparoscopic donor hepatectomy became possible, but with some limitations. Advancements in robotic technology made it possible to overcome these shortcomings and maximize the advantages of minimally invasive surgery in transplantation. For this reason, some centers have started robotic donor hepatectomy. Our study aimed to introduce our early experience of robotic donor right hepatectomy and investigate the feasibility of this surgery. This study included 10 (30%) living donors who underwent pure robotic donor right hepatectomy at Dong-A University Hospital from January 1, 2020 to December 31, 2021. The medical records were analyzed to determine the short-term outcomes of these patients. The total operation time and warm ischemic time were 396.6 min ± 62.7 min and 19.7 min± 5.6 min, respectively. Moreover, there was no transfusion during the operation and no other port use and open conversion. The average real graft volume was 590 mL ± 73.5 mL, and the mean hospital stay was 8.7 d ± 2.6 d. There have been no specific complications noted in the donor group. Based on our positive experience with pure robotic right hepatectomy for a liver donor, the robotic technique may be a new option for achieving minimally invasive surgery for a liver donor.

Indocyanine Green Near-Infrared Fluorescence Cholangiogram During Pure Laparoscopic Living Donor hepatectomy For Optimal Bile Duct Division

Introduction: Biliary complications in living donor liver transplantation are most common and troubled problem to liver transplant surgeons, various method to decease biliary complications has been studied and determining the optimal bile duct division point is important to decrease complication rate. Intraoperative cholangiogram has been standard method to determine the optimal bile duct division point for conventional donor hepatectomy, but in laparoscopic donor hepatectomy, indocyanine green(ICG) near-infrared fluorescence cholangiogram is alternative option of intraoperative cholangiogram. We compared conventional cholangiogram and ICG near-infrared fluorescence cholangiogram to determine optimal bile duct division point in pure laparoscopic living donor hepatectomy. Method: From May 2016 to October 2019, 80 cases of pure laparoscopic donor hepatectomy has been performed in Kyungpook national university hospital. Conventional cholangiogram was used in 45 cases, ICG near-infrared fluorescence cholangiogram was used in 35 cases. We compared two groups in preoperative bile duct anomaly of donor, operative time and postoperative complications. Result: In bile duct anomaly of donors, there were no differences between two groups. Operative time was much longer in conventional cholangiogram group because conventional cholangiogram procedure itself was time consuming. In one donor of conventional group, biliary complication occurred. Bile leakage from the cutting edge of the remnant right hepatic duct was identified, resolved by ERBD insertion. Conclusion: ICG near-infrared fluorescence cholangiogram is more easier and convenient method to determine proper bile duct division point and is helpful to decrease biliary complications by confirming the real time fluorescence image of bile duct.

Pure Laparoscopic vs. Open Right Hepatectomy in Living Liver Donors: Bench-Surgery Time.

Background: Recently, there have been several reports on pure laparoscopic donor right hepatectomy (PLDRH), but the effect of pure laparoscopy on bench surgery has not been evaluated. This study aimed to compare bench-surgery time between PLDRH and conventional donor right hepatectomy (CDRH).Methods: We retrospectively reviewed the medical records of 758 live liver donors between January 2012 and December 2019. We divided the patients into two groups: between January 2012 and September 2015, when we exclusively performed CDRH, and between March 2016 and December 2019, when PLDRH was standardized. We excluded all other types of graft donor hepatectomy, laparoscopic assisted donor hepatectomy, and cases with no recorded data.Results: In total, 267 donors were included in the PLDRH group and were compared with 247 donors in the CDRH group. Similar proportions of graft vascular variations were observed between the two groups. The mean bench-surgery time was longer in the PLDRH group than in the CDRH group (49.3 ± 19.9 vs. 39.5 ± 17.5 min; P < 0.001).Conclusion: The bench-surgery time was longer in the PLDRH group than the CDRH group, regardless of whether the vascular network was reconstructed. Expertise in bench-surgery as well as donor surgery and recipient surgery is mandatory for PLDRH to be safe and feasible.

Impact of previous abdominal surgery on laparoscopic donor hepatectomy for living donor liver transplantation

Impact of previous abdominal surgery on laparoscopic donor hepatectomy for living donor liver transplantation

Bilateral continuous erector spinae plane block using a programmed intermittent bolus regimen versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: A randomized controlled trial

Study objectiveTo determine if continuous bilateral erector spinae plane (ESP) blocks would improve the postoperative analgesia in the first 48 h after laparoscopic donor hepatectomy, compared to intrathecal morphine (ITM). DesignProspective, randomized controlled trial. SettingA single tertiary care center from October 2019 and September 2020. PatientsA total of 60 donors scheduled to undergo elective laparoscopic right hepatectomy. InterventionsSixty donors were randomized to receive either bilateral continuous T8 ESP blocks with a programmed intermittent bolus regimen of 10 mL 0.2% ropivacaine every 3 h for 48 h (n = 30) or 400 μg ITM (n = 30), in addition to IV fentanyl PCA and multimodal analgesia. MeasurementsThe primary outcome was cumulative opioid consumption over the first 48 h, expressed as IV morphine equivalents. Secondary outcomes included pain scores, Quality of Recovery-15 scores, ambulation within 24 h, time to first flatus, and opioid-related adverse drug events over 72 h. Main resultsFifty-nine donors were analyzed. Cumulative 48-h opioid consumption was similar between the ITM and ESP groups (29.8 ± 18.2 vs. 35.1 ± 21.9 mg, mean difference (ESP-ITM) (95% CI), 5.3 (−11.5 to 22) mg; p > 0.99). Resting pain scores at 48 and 72 h postoperatively were significantly lower in the ESP group (0 [0–2] vs. 3 [1.5–3], and 0 [0–2] vs. 3 [1–3] respectively, both p<0.001) (Goldaracena and Barbas, 2019; Ko et al., 2009; Choi et al., 2007 [1–3]) respectively, both p < 0.001). The ESP group had significantly lower incidences of postoperative nausea, vomiting, and pruritus at all timepoints. There were no differences in recovery outcomes. ConclusionsContinuous ESP blocks did not reduce cumulative 48-h opioid consumption compared to 400 μg ITM after laparoscopic donor hepatectomy, but it was associated with a significantly reduced risk of postoperative nausea, vomiting and pruritus. Clinical trial number and registry URLClinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0004313; date of registration: October 15, 2019; principal investigator's name: Justin Sangwook Ko.

Surgical Techniques and Outcomes of Pure Laparoscopic Donor Right Posterior Sectionectomy for Living Donor Liver Transplantation.

Right posterior section (RPS) graft for living donor liver transplantation (LDLT) is an alternative graft in a live liver donor with insufficient remnant left lobe volume and portal vein anomaly.(1,2) In recent decades, laparoscopic liver resection (LLR) has been widely adopted by hepatobiliary surgeons, and the indication for LLR have expanded to donor hepatectomy.(3,4) Laparoscopic-approach donor surgery would be ideal for liver donation in healthy individuals, due to the fast return to normal life and satisfaction with the incisional scar. However, there have been no reports regarding laparoscopic donor hepatectomy for RPS graft. Herein, we report surgical outcomes and techniques of pure laparoscopic donor right posterior sectionectomy (PLDRPS) for LDLT. The institutional review boards of our center (number 2019-03-080) approved this study.

Comparison of laparoscopic and open living donor hepatectomy: A meta-analysis.

Laparoscopic donor hepatectomy (LDH), accepted as a minimally invasive approach, has become increasingly popular for living donor liver transplant. However, the outcomes of LDH remain to be fully clarified when compared with open living donor hepatectomy. Thus, our meta-analysis was designed to assess the efficacy of laparoscopic in comparison with conventional open donor hepatectomy.The PubMed, Cochrane, and Embase electronic databases were searched to identify the articles concerning the comparison of the efficacy of laparoscopic versus open surgery in treatment of living donor liver transplantation updated to March, 2020. The main search terms and medical Subject Heading terms were: “living donor,” “liver donor,” “minimally invasive,” “laparoscopic surgery,” and “open surgery.” After rigorous evaluation on quality, the data was extracted from eligible publications. The outcomes of interest included intraoperative and postoperative results.The inclusion criteria were met by a total of 20 studies. In all, 2001 subjects involving 633 patients who received laparoscopic surgery and 1368 patients who received open surgery were included. According to the pooled result of surgery duration, the laparoscopic surgery was associated with shorter duration of hospital stay (MD = −1.07, 95% CI −1.85 to −0.29; P = .007), less blood loss (MD = −57.57, 95% CI −65.07 to −50.07; P < .00001), and less postoperative complications (OR = 0.61, 95% CI 0.44–0.85; P = .003). And the open donor hepatectomy achieved a trend of shorter operation time (MD = 30.31, 95% CI 13.93–46.69; P = .0003) than laparoscopic group. Similar results were found in terms of ALT (P = .52) as well as the AST (P = .47) peak level between the 2 groups.LDH showed the better perioperative outcomes as compared with open donor hepatectomy. The findings revealed that LDH may be a feasible and safe procedure for the living donor liver transplantation.

Pure Laparoscopic Donor Hepatectomy: Right Posterior Section Graft

BackgroundThe use of laparoscopic liver resection (LLR) is widespread owing to its several advantages, especially smaller incision (Kaneko et al., Ann Gastroenterol Surg 1:33–43, 1; Ciria et al., Surg Endosc 34:349–360, 2). However, both posterior sectionectomy and donor hepatectomy are extremely difficult procedures to perform in LLR (Hasegawa et al., Ann Gastroenterol Surg 2:376–382, 3; Soubrane and Kwon, J Hepatobiliary Pancreat Sci 24:E1–E5, 4; Takahara et al., Transplantation 101:1628–1636, 5; Lee et al., Clin Transplant 33:e13683, 6; Hong et al., Surg Endosc 33:3741–3748, 7; Rhu et al., J Hepatobiliary Pancreat Sci 27:16–25, 8). Moreover, the right posterior section graft procurement is also difficult even in open laparotomy procedure (Sugawara et al., Transplantation 73:111–114, 9; Hwang et al., Liver Transpl 10:1150–1155, 10; Hori, Kirino, and Uemoto, Hepatol Res 45:1076–1082, 11; Kusakabe et al., Liver Transpl 26:299–303, 12). The pure laparoscopic donor posterior sectionectomy has not been reported yet. Therefore, we aimed to introduce a novel procedure through a video clip. MethodsThe donor was placed in the semi-left lateral decubitus position with the reverse Trendelenburg position using a bean bag device. The right liver was mobilized, and the right hepatic vein was exposed. To adopt the liver hanging maneuver, a tape was inserted between the middle and right hepatic veins along the inferior vena cava. The posterior Glissonean pedicle was encircled and controlled, and the liver parenchyma was completely transected using the liver hanging maneuver. The vessels to the posterior section were respectively isolated. The posterior branches of the hepatic duct, hepatic artery, and portal vein were cut. The right hepatic vein was divided, and the graft liver was retrieved via a suprapubic incision. This study was approved by institutional ethics board (No. MH2019-119), and informed consent was taken from the patient. ResultsThe overall surgical time was 503 min, and the blood loss was 400 mL. No complications were observed, and the donor was discharged from the hospital on postoperative day 11. ConclusionThis is the first report of pure laparoscopic donor hepatectomy of the posterior section graft. This procedure is more difficult than other laparoscopic donor hepatectomies because it involves parenchymal transection in the right intersectional plane and dissection of the posterior branches of hilar vessels.

Pure laparoscopic versus open donor hepatectomy for adult living donor liver transplantation - A systematic review and meta-analysis.

Background:Pure laparoscopic donor hepatectomy (PLDH) for adult living donor liver transplantation (LDLT) remains controversial. The aim of this study was to undertake a systematic review and meta-analysis of donor outcomes following PLDH for adult LDLT.Materials and Methods:Systematic review in line with the meta-analysis of observational studies in epidemiology guidelines.Results:Eight studies were included in the systematic review and six in the meta-analysis. A total of 575 donors underwent PLDH for adult LDLT. The mean donor age was 32.8 years with a BMI of 23.4 kg/m2 and graft weight of 675 g. The mean operative time was 353 min and the conversion rate was 2.8% (n = 16). Overall morbidity was 10.8% with 1.6% major complications (Clavien-Dindo grade 3b), zero mortality and 9.0 days length of stay (LOS). The meta-analysis demonstrated that the operative time was significantly shorter for the open donor hepatectomy group (mean difference 29.15 min; P = 0.006) and the LOS was shorter for the PLDH group (mean difference −0.73 days; P = 0.02), with a trend towards lesser estimated blood loss in PLDH group. However, no difference between the two groups was noted in terms of overall morbidity or major complications.Conclusions:Perioperative outcomes of PLDH are similar to the standard open approach in highly specialised centers with trend towards lesser blood loss and overall shorter hospital stay. Careful donor selection and standardisation of the technique are imperative for the successful implementation and adoption of the procedure worldwide.

Can Living Donor Liver Transplantation in the United States Reach Its Potential?

Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end-stage liver disease. LDLT still only makes up a very small proportion of all liver transplantations performed each year, but there are many innovations taking place in the field that may increase its acceptance among both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through nondirected donation, paired exchange, transplant chains, transplant of ABO-incompatible donors, and transplants in patients with high Model for End-Stage Liver Disease scores. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy, and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center-level behavior, such as ensuring surgical expertise and providing culturally competent education, will help toward LDLT expansion. Although it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the past 2 years.

Upper midline incision could be standard procedure for living donor right hepatectomy

Pure laparoscopic donor hepatectomy has not been performed in almost living right donor hepatectomy (LDRH) because this is more technically demanding. Instead, several studies have described LDRH using upper midline incision (UMI) to reduce donor morbidity. Herein, we describe our experience with small UMI as a standard procedure for LDRH. We retrospectively reviewed the outcomes of 444 living donor right hepatectomy (LDRH) at our institution from January 2010 to June 2019; 124 donors received LDRH using UMI (UMI group), whereas 320 donors underwent LDRH using J shaped incision (J shaped group). This incision has been standard procedure for LDRH regardless of graft type, body mass index, graft weight or vascular variation since 2016. Patient demographics, intraoperative parameters, laboratory data and postoperative complications were compared between the 2 groups. The mean size of the UMIs is 12.9 cm and the overall complication rates did not differ significantly between the 2 groups. However, postoperative hospital stay and operation time in UMI group were significantly lower than those in J shaped group. In multivariate logistic regression analyses, only large graft (> 900 g) and severe hepatic steatosis (≥ 15%) were significant risk factors for difficult hepatectomy but not related to type of incision. Moreover, in high risk group for operation (donors with large graft or severe graft steatosis), neither the operation time nor intraoperative blood loss in UMI group were higher than those in J shaped group. LDRH could be safely performed under small UMI and could be considered as standard procedure during LDRH.

Pure laparoscopic living donor hepatectomy for the right posterior segment graft

The right posterior segment (RPS) graft was introduced as an alternative to expand donor pool. The first LDLT case using an RPS graft was reported in 2001, the RPS graft has not been widely used in LDLT because of lack of donors with suitable anatomical variation, technical challenge for safe donor hepatectomy and surgical difficulties in recipient operation. We present the 3 cases of pure laparoscopic donor hepatectomy with RPS graft. For donor evaluation, we performed laboratory test, abdominal ultrasonography and dynamic computed tomography (CT) scan. Graft selection was determined based on volumetric analysis. In 3 cases of RPS graft, the ratio of the remnant liver volume/whole liver volume was less than 0.3 and left lobe graft was small for metabolic demand of recipients. All 3 donors had type 3 portal vein variation. The Graft Recipient Weight Ratio (GRWR) was 0.72, 0.81, and 1.34 in each case. Preoperative magnetic resonance cholangiopancreatography (MRCP) was performed to evaluate bile duct anomaly. In 3 cases, we had no open conversion, intraoperative and postoperative transfusion. Cut surface bile leakage occurred in one case, but bile leakage decreased without procedure or intervention, the donor discharged at postoperative day 9. He had no more complications. Recipients were recovered uneventfully and discharged. To meet the donor's safety and recipient's metabolic demand, graft selection is one of the important factors in LDLT, the RPS graft is an alternative to expand donor pool. However, thorough preoperative evaluation to understand the anatomical variation is necessary even for experienced transplant surgeons.

Pure laparoscopic versus open right hepatectomy including the middle hepatic vein for living donor liver transplantation

Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the era of minimally invasive surgeries.However, the outcomes of pure laparoscopic donor right hepatectomy (PLDRH) including the middle hepatic vein (MHV) are relatively less known than for left lateral sectionectomy or right hepatectomy. This study aimed to report our experience with and the outcomes of PLDRH including the middle hepatic vein (MHV) and to compare these outcomes with conventional donor right hepatectomy (CDRH) including the MHV. The medical records of living liver donors between January 2002 and December 2020 at Seoul National University Hospital were retrospectively. To minimize selection bias, donors who underwent CDRH including the MHV after the initiation of the PLDH program were excluded. Finally, there were 42 donors who underwent CDRH including the MHV and 37 who underwent PLDRH including the MHV. The total operation time was 284 minutes versus 250 minutes (p = 0.01) and estimated blood loss was 394 mL versus 208 mL(p = 0.01). There were no postoperative complications in the PLDRH including the MHV group. The rate of complications in recipients was similar in both groups. PLDRH including the MHV appears to be safe and feasible. Further analysis including longterm outcomes is needed.

Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging During Laparoscopic Donor Hepatectomy.

Indocyanine green (ICG) near-infrared fluoroscopy has been recently implemented in pure laparoscopic donor hepatectomy (PLDH). This study aims to quantitatively evaluate the effectiveness of ICG fluoroscopy during liver midplane dissection in PLDH and to demonstrate that a single injection of ICG is adequate for both midplane dissection and bile duct division. Retrospective analysis was done with images acquired from recordings of PLDH performed without ICG (pre-ICG group) from November 2015 to May 2016 and with ICG (post-ICG group) from June 2016 to May 2017. 30 donors from the pre-ICG group were compared with 46 donors from the post-ICG group. The operation time was shorter (P = 0.002) and postoperative peak aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were lower (P = 0.031 and P = 0.019, respectively) in the post-ICG group than the pre-ICG group. Within the post-ICG group, the color intensity differences between the clamped versus nonclamped regions in the natural, black-and-white, and fluorescent modes were 39.7 ± 36.2, 89.6 ± 46.9, and 19.1 ± 36.8 (mean ± SD, P < 0.001), respectively. The luminosity differences were 37.2 ± 34.5, 93.8 ± 32.1, and 26.7 ± 25.7 (P < 0.001), respectively. Meanwhile, the time from when ICG was injected to when the near-infrared camera was turned on for bile duct visualization was 85.6 ± 25.8 minutes. All grafts received from the 46 donors were successfully transplanted. In conclusion, ICG fluoroscopy helps to reduce operation time and lower postoperative AST/ALT levels. ICG injection visualized with black-and-white imaging is most effective for demarcating the liver midplane during PLDH. A single intravenous injection of ICG is sufficient for midplane dissection as well as bile duct division.

Review of surgical techniques for performing laparoscopic donor hepatectomy

Living related liver transplantation has proved to be an effective, safe and radical method for treating end-stage liver diseases. In the last decade, a laparoscopic approach to donor hepatectomy has been gradually introduced into clinical practice. According to world literature, there are presently no uniform standards for performing laparoscopic liver resections in living donors. This literature review considers almost all methods for performing this surgery in living donors. These methods are described in transplant centers around the world.

Purely laparoscopic left donor hepatectomy with middle hepatic vein and caudate lobe

Presenter: Essa Aleassa MD | Cleveland Clinic Foundation Background: The volume of liver transplantation has been limited in North America by the low number of liver grafts available from deceased donors. Furthermore, the invasiveness of performing an open living donor hepatectomy makes it a less appealing option to the public. The introduction of minimally invasive living donor hepatectomy has helped increase the number of liver living donors. This approach is growing in North America not yet disseminated yet due to its complexity. This video aims to showcase our approach to a purely laparoscopic left donor hepatectomy that includes the caudate lobe as well as the middle hepatic vein in an effort to maximize the volume and function of the donated left liver lobe graft. Methods: A 29-year-old male underwent a purely laparoscopic left liver lobe living donor with caudate and middle hepatic artery. The patient was preoperatively assessed and noted to be a suitable donor from an anatomical and functional standpoint. The left liver lobe with preserved middle hepatic vein and caudate lobe was resected and donated to a living donor liver transplant recipient. Results: The patient tolerated the procedure without any complications. The operative time was 6 hours and 20 minutes and the estimated blood loss was 200cc. The patient tolerated the procedure well and was discharged on postoperative day 5. Conclusion: Purely laparoscopic donor hepatectomy is a highly advanced procedure that aims to decrease enhance the recovery of living donors. Furthermore, this approach is promising to increase the number of liver transplantation performed in North America.

Purely laparoscopic left donor hepatectomy with middle hepatic vein and caudate lobe

Purpose: The volume of liver transplantation has been limited in the Western part of the globe by the low number of liver grafts available from deceased donors. Furthermore, the invasiveness of performing an open living donor hepatectomy makes it a less appealing option to the public. The introduction of minimally invasive living donor hepatectomy has helped increase the number of liver living donors. This approach is growing in North America not yet disseminated yet due to its complexity. This video aims to showcase our approach to a purely laparoscopic left donor hepatectomy that includes the caudate lobe as well as the middle hepatic vein in an effort to maximize the volume and function of the donated left liver lobe graft.

Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging during Laparoscopic Donor Hepatectomy

Introduction: Indocyanine green (ICG) near-infrared fluoroscopy has been widely implemented in laparoscopic donor hepatectomy for precise demarcation of the liver midplane. This study aims to show the effectiveness of ICG fluoroscopy and to determine that a single injection of ICG is adequate for both midplane dissection and bile duct division.

Duct Division in Pure Laparoscopic Donor Hepatectomy: DELHI Technique

Background: Pure laparoscopic donor hepatectomy (PLDH) has become accepted surgical procedure in living donor liver transplantation (LDLT). This study aimed to report our technique of duct division in PLDH: Duct division by Extraglissonian Looping after Hilar plate Incision (DELHI).