Laparoscopic Living Donor Hepatectomy Research Articles

Short and mid-term outcomes of laparoscopic living donor hepatectomy: a European experience

Short and mid-term outcomes of laparoscopic living donor hepatectomy: a European experience

Various Retracting techniques for the laparoscopic living donor hepatectomy: double rubber extraction to facilitate liver resection

Various Retracting techniques for the laparoscopic living donor hepatectomy: double rubber extraction to facilitate liver resection

Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: A retrospective cohort study

Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: A retrospective cohort study

A commentary on 'Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study' (Int J Surg 2022;108:107000).

A commentary on 'Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study' (Int J Surg 2022;108:107000).

Comment on 'Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study'.

Comment on 'Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study'.

Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors.

This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092-46.789, P <0.001), division-free margin<5mm from the main duct (OR=2.624, CI=1.030-6.686, P =0.043), and estimated blood loss during operation (OR=1.002, CI=1.001-1.003, P =0.008), while the Pringle maneuver (OR=0.300, CI=0.110-0.817, P =0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773-51.083, P =0.001). Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy.

A commentary on "Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study" (Int J Surg 2022; 108: 107000).

Dear Editor, The article by Dr Kim et al.1 was very interesting. This article provided the first analysis in which two minimally invasive surgical techniques, laparoscopic living donor right hemihepatectomy (LLDRH) and robotic living donor right hemihepatectomy (RLDRH), were compared for living donor hepatectomy at a single center. The author found that RLDRH resulted in less intraoperative bleeding but had comparable postoperative outcomes to LLDRH. Moreover, donors with hilar structure anatomic variation were more likely to undergo RLDRH. In addition, the standardized procedures for RLDRH might help set up pure minimally invasive procedures and facilitate the safe implementation of laparoscopic approaches. Despite being inspiring and thought-provoking, we have the following comments: First, the authors used moving average charts for graft-out time and a cumulative sum (CUSUM) analysis to assess the learning curves for RLDRH and LLDRH. The results showed that LLRDH stabilized earlier than RLDRH. The authors recommended LLRDH be performed based on the experience of RLDRH and the same surgical technique because of the difference in duration between the two procedures. However, we believe that the learning curves may not be accurate enough. To be frank, the most important process for RLDRH and LLDRH is partial hepatectomy. In addition to being exposed to this operation during transplantation, surgeons might also use liver resection skills in other operations, such as tumor resection, which is also a learning process for the operator. Therefore, we believe that only including the data of minimally invasive donor hepatectomy as the establishment of learning curve may cause the learning curve to be less accurate. Second, to reduce the bias in patient selection, the authors compared the outcomes of RLDRH and LLDRH in subgroups after 2019. We know that the surgeon in the RLDRH group had already completed 3 years of training before 2019, while that in the LLDRH group had just begun. Patients undergoing living hepatectomy are generally healthy people; thus, we speculate that the surgical approach and the surgeon’s skills are more likely to influence the short-term outcome. Third, the learning curves for both RLDRH and LLDRH showed a tendency to be unstable initially. But they gradually stabilized as the number of procedures performed increased. We hypothesized that if the authors had performed a subgroup comparison of patients after the learning curve had stabilized, they might reduce the bias due to differences in surgical proficiency. Finally, we are not questioning the relevancy of this impactful team study by presenting these comments reflecting some personal opinions we want to communicate with the authors. We appreciate the authors and the International Journal of Surgery for publishing this clinically significant study that will advance the development and progress of living donor hepatectomy. Ethical approval Not available. Sources of funding Chongqing Technology Innovation and Application Development Special Key Project (No. CSTC2021jscx-gksb-N0009). Author contribution S.-Y.Z., Z.-P.L., Y.-S. Y., T. Y.: manuscript preparation. X.-J. W.: critical revision. Final approval of manuscript is done by all authors. Conflict of interest disclosure All authors have declared no conflict of interest. Guarantor Xiao-Jun Wang.

Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: A retrospective cohort study

BackgroundBoth laparoscopic living donor right hemihepatectomy (LLDRH) and robotic living donor right hemihepatectomy (RLDRH) have been developed for minimally invasive donor hepatectomy (MIDH), although comparative analysis between the two surgical modalities is lacking. This study aims to compare surgical outcomes of LLDRH and RLDRH at a single institution. Materials and methodsFrom March 2016 to March 2022, 171 patients who underwent MILH of right liver were enrolled and divided into RLDRH and LLDRH. Two surgeons with experience in both techniques performed all procedures. Clinical characteristics, perioperative outcomes of donor and recipient, and donor anatomic variations were compared between both groups, and learning curves were estimated. Subgroup analysis was also performed, including only donors recruited after 2019, when LLDRH was initiated at our institution. ResultsRLDRH and LLDRH were performed for 102 and 69 patients, respectively. Operative time was significantly longer for RLDRH than LLDRH (464 vs. 407 min, P < 0.001), although estimated blood loss was lower in RLDRH (104 vs. 238 mL, P = 0.002). Incidence of major complications was similar in both groups. After 2019, significantly more RLDRH vs. LLDRH patients had variation in the hepatic artery (14.3% vs. 2.9%, P = 0.020) and portal vein (16.1% vs. 4.3%, P = 0.027). Learning curve for RLDRH was stabilized after approximately the 16th case, whereas that of LLDRH stabilized immediately. ConclusionRLDRH resulted in less intraoperative bleeding and comparable postoperative outcomes than LLDRH. Moreover, since 2019, RLDRH has been employed more frequently for donors with hilar structure anatomic variations. Based on our single-center experience, we propose that standardized procedures for RLDRH might help set up pure minimally invasive procedures for donor hepatectomy and facilitate safe implementation of laparoscopic approaches.

Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies.

This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p<0.001) and transition period (48.1% vs. 24.3%; p<0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p=0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p=0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p=0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p<0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p<0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p<0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p=0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.

Complete transition from open to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomy

Complete transition from open to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomy

Complete transition from open to laparoscopic living donor hepatectomy: 8-year experience with more than 500 laparoscopy cases

Complete transition from open to laparoscopic living donor hepatectomy: 8-year experience with more than 500 laparoscopy cases

The outcomes of pure laparoscopic living donor hepatectomy at small volume center

The outcomes of pure laparoscopic living donor hepatectomy at small volume center

Change of Anesthetic Management From Open to Laparoscopic Living Donor Right Hepatectomy After Learning Curve

In our hospital, open living donor hepatectomy (OLDH) began in 1996 and laparoscopic living donor hepatectomy (LLDH) began in 2013. In this study, we focus on the change of anesthetic management from OLDH to LLDH. Under the approval of the Institutional Review Board of our hospital, medical records of the last 2 years (2011 and 2012 vs 2019 and 2020) of each OLDH and LLDH era were collected. Left hepatectomy in any period and OLDH during the LLDH era were excluded. There were 175 OLDHs and 213 LLDHs. We performed 836 cases of OLDH before 2011 and 206 cases of LLDH before 2019. Laryngeal mask airway replaced intubation in half of LLDH cases. Erector spinae plane block was performed in a quarter of LLDH cases. Lung-protective ventilation with low tidal volume and positive end-expiratory pressure were applied for LLDH. Additional peripheral venous line was decreased, and there was no central venous catheterization. Anesthesia duration time was reduced and crystalloid infusion per hour was also decreased. There was no intraoperative transfusion and there was no difference in postoperative transfusion incidence. Reoperation rate was not different. Only 1 donor in OLDH transferred to the intensive care unit after the operation because of uncontrolled hypertension. Length of hospital stay was decreased. As the surgical tactics for living liver donors become less invasive, the anesthetic strategy also becomes less invasive. In addition, new types of airway management, ventilation method, and analgesic technique have been introduced.

Complete Transition from Open to Laparoscopic Living Donor Hepatectomy: 8-Year Experience with More than 500 Laparoscopy Cases

Background: We designed this study to comprehensively review the laparoscopic living donor liver transplantation of our institution. Method: Living donor liver transplantation cases performed since the first laparoscopic living donor hepatectomy, until reaching 500th laparoscopic cases were reviewed. Laparoscopic cases were compared to open cases in a yearly basis, regarding the donor selection, donor morbidity, recipient morbidity and operation time. Results: During the period of May 2013 to July 2021, 754 living donor liver transplantations, 506 laparoscopic and 247 open cases were performed. Complete transition to laparoscopy was achieved in 2020, performing 112 transplantations laparoscopically. Variation of bile duct type of donor became similar in 2018. (P=1.000) There were no differences in the occurrence of grade III complication of donor and recipient throughout the study period. Mean donor operation time were significantly longer in the laparoscopy group which became similar since 2017 (P=0.313) There were no differences in the mean operation time of recipients throughout the study period. Regarding graft survival and overall survival of the recipient, there were no difference between the two group throughout the period. Conclusions: In the initial period, donor selection existed especially for bile duct variation maintaining the safety of the donor and recipient. However, with accumulated experience, complete transition to laparoscopy became possible after 7 years of practice.

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.

The outcomes of pure laparoscopic living donor hepatectomy at small volume center

The outcomes of pure laparoscopic living donor hepatectomy at small volume center

Complete transition from open to laparoscopic living donor hepatectomy: 8-year experience with more than 500 laparoscopy cases

Complete transition from open to laparoscopic living donor hepatectomy: 8-year experience with more than 500 laparoscopy cases

A Novel Technique for Bile Duct Division During Laparoscopic Living Donor Hepatectomy to Overcome Biliary Complications in Liver Transplantation Recipients: "Cut and Clip" Rather Than "Clip and Cut".

This study was designed to analyze the clinical impact of a new bile duct division technique during laparoscopic living donor hepatectomy. Laparoscopic donor right hepatectomies performed by a single surgeon between December 2016 and August 2019 were included. Magnetic resonance cholangiopancreatography of the donors was reconstructed, and the length of the common channel of the dividing intrahepatic duct was measured. Patients were divided into 2 groups based on the bile duct division techniques of "clip and cut" versus "cut and clip." Outcome of bile duct division was categorized based on the graft and bile duct type and number of bile duct openings. A total of 147 transplantations were included. Outcomes in the "cut and clip" group were better than those in the "clip and cut" group with regard to obtaining an adequate division point (94.2% versus 78.8%; P = 0.019). The "cut and clip" showed superior biliary stricture-free survival than the "clip and cut" group (hazard ratio [HR], 0.456; confidence interval [CI], 0.217-0.957; P = 0.038) whereas recipients with hepaticojejunostomy (HR, 3.358; CI, 1.090-10.350; P = 0.035) and bile duct type other than type I (HR, 2.214; CI, 1.143-4.289; P = 0.018) showed increased risk for biliary stricture-free survival. Better outcome in terms of obtaining a single opening was also obtained in the "cut and clip" group (68.2% versus 84.6%; P = 0.040), and this difference was significant especially with a common channel shorter than 10 mm (45.5% versus 81.2%; P = 0.043). The "cut and clip" technique showed superior outcomes to the "clip and cut" technique in terms of fewer bile duct openings and biliary stricture-free survival of the recipients.

Decreasing the operation time of living donor liver transplantation in the era of laparoscopic living donor hepatectomy

Decreasing the operation time of living donor liver transplantation in the era of laparoscopic living donor hepatectomy

Advances in the surgical outcomes of 300 cases of pure laparoscopic living donor right hemihepatectomy divided into three periods of 100 cases: a single-centre case series.

Minimally invasive surgery has been widely used for hepatobiliary operations. This study aimed to determine the safety and feasibility of pure laparoscopic living donor right hepatectomy. From November 2015 to April 2019, 300 cases of adult pure laparoscopic living donor right hepatectomy performed at Seoul National University Hospital were divided into three subgroups of periods 1-3 of 100 cases each: 1-100, 101-200, and 201-300, respectively. We retrospectively reviewed and analysed the safety and feasibility outcomes. The operative time (period 1: 318.9±62.2 min, period 2: 256.7±71.4 min, period 3: 227.7±57.4 min) and blood loss (period 1: 419.7±196.5 mL, period 2: 198.9±197.2 mL, period 3: 166.0±130.0 mL) gradually decreased (P<0.01). Similarly, the length of hospital stay decreased (period 1: 8.1±2.0 days, period 2: 7.3±3.1 days, period 3: 6.9±2.4 days, P<0.01). There was no requirement for intraoperative transfusions or care in the intensive care unit. The overall complication rate was 20/300 (6.7%), of which 8/300 (2.7%) were Clavien-Dindo grade III and above. Complications were not different among the three periods. In terms of anatomical variations, the incidences of multiple portal veins, multiple hepatic arteries, and multiple bile ducts were 32/300 (10.7%), 11/300 (3.7%), and 161/300 (53.7%), respectively. No differences were found among the three periods. Owing to the technical improvements over time, pure laparoscopic living donor hepatectomy is currently feasible and safe even for donors with anatomical variations.