Pure Laparoscopic Donor Hepatectomy Research Articles

Criteria for selecting living liver donors to optimize recipient outcomes in pure laparoscopic donor right hepatectomy: a cohort study.

Although the adoption of pure laparoscopic donor hepatectomy has expanded driven by considerations of donor cosmesis and function, the criteria for selecting candidates for pure laparoscopic donor right hepatectomy (PLDRH) continue to be debated. This study aimed to delineate the distinctive characteristics of donors and recipients who underwent conventional open-donor right hepatectomy (CDRH) during the era of PLDRH. We conducted a retrospective review of a prospectively collected single-center database encompassing all right hepatectomies at OOOO from April 2016 to December 2021, a period during which there were no absolute contraindications for PLDRH. During the exclusive PLDRH period, there were still 63 cases of CDRH alongside 362 cases of PLDRH. The CDRH donors were older, had a lower estimated remnant liver volume, and a higher incidence of expected multiple openings in the portal vein and bile duct based on preoperative imaging compared with PLDRH donors. In the subgroup analysis, including only donors meeting two or more criteria (age ≥40y, estimated remnant liver volume ≥35%, or multiple anticipated vessel openings), recipients in the PLDRH group exhibited significantly more early major complications (P=0.029) compared with those in the CDRH group. As PLDRH gains traction in practice, it is essential to acknowledge that specific donor conditions, such as advanced age, limited remnant liver volume, and anticipation of multiple portal or bile duct openings, may merit contemplating CDRH as a means of optimizing recipient outcomes.

Insights from Seoul National University Hospital's experience: a systematic review of pure laparoscopic donor hepatectomy progression.

Following its initial execution in November 2015, pure laparoscopic donor hepatectomy (PLDH) has gained acceptance as a conventional practice at Seoul National University Hospital (SNUH). It is noteworthy that a significant proportion of cases entail full right hepatectomies, which are acknowledged to be technically demanding. As expertise and knowledge have been accrued, the pure laparoscopic technique has been extended to encompass liver recipients as a viable option in SNUH. The aim of this review is to present the developmental progression of PLDH, with a focus on pure laparoscopic donor right hepatectomy (PLDRH), at SNUH. This includes the standardization process, which can be achieved by sharing the hospital's accumulated experience and previous reports. Various types of graft, including full right, left, left lateral section, and monosegment, were procured by pure laparoscopic technique. The criteria for selection were expanded to include donors with variations in the anatomy of the portal vein and bile duct. Additionally, the procedure of PLDRH was determined to be safe and viable for donors with high body mass index and larger graft weight. In conclusion, this review demonstrates the alterations implemented throughout our evolution from restricted to inclusive criteria for donor selection, leading to a complete shift from open surgery to pure laparoscopic procedures in donor hepatectomy and eventually pure laparoscopic living donor liver transplantation (LDLT) in recipient.

Postoperative outcomes and quality of life after pure laparoscopic versus open donor hepatectomy in adult-to-adult living donor liver transplantation: first report from Thailand

Postoperative outcomes and quality of life after pure laparoscopic versus open donor hepatectomy in adult-to-adult living donor liver transplantation: first report from Thailand

Successful implementation of pure laparoscopic right donor hepatectomy in a small center with limited experience: the role of proctorship program

Successful implementation of pure laparoscopic right donor hepatectomy in a small center with limited experience: the role of proctorship program

What are operating-time-determining factors of pure laparoscopic donor hepatectomy for adult recipients?

What are operating-time-determining factors of pure laparoscopic donor hepatectomy for adult recipients?

Risk-Adjusted Assessment of the Learning Curve for Pure Laparoscopic Donor Hepatectomy for Adult Recipients.

Studies on pure laparoscopic donor hepatectomy (PLDH) have been reported. However, only few studies have reported on the learning curve of PLDH. In this report, we aimed to determine the learning curve of PLDH in adult patients using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) analyses. The data of donors who underwent PLDH at a single center between December 2012 and May 2022 were retrospectively reviewed. The learning curve was evaluated using the CUSUM and RA-CUSUM methods based on surgery duration. Forty-eight patients were finally included in the present study. The mean operation time was 393.6 ± 80.3min. PLDH was converted to laparotomy in three cases (6.3%). According to the Clavien-Dindo classification, nine cases (18.8%) had higher-than-grade III postoperative complications and the most frequent complications were biliary complications. The CUSUM graph shows two peaks, at the 13th and 27th case. The multivariate analysis revealed that a body mass index ≥ 23kg/m2 and intraoperative cholangiography were the only factors that were independently associated with longer operation time. Based on these results, an RA-CUSUM analysis was performed to assess the learning curve, which showed a decrease in the learning curve after 33 to 34 PLDH procedures. A learning curve effect was demonstrated in this study after 33 to 34 PLDH procedures. There are relatively many biliary complications, and it is necessary to further examine the method of bile duct transection.

Pure laparoscopic donor hepatectomy: Experience of 556 cases at Seoul National University Hospital

Pure laparoscopic donor hepatectomy (PLDH) has become a routine procedure at Seoul National University Hospital, and the pure laparoscopic method is now being applied to liver recipients as well. This study aimed to review the procedure and outcomes of PLDH to identify any areas that required improvement. Data from 556 donors who underwent PLDH between November 2015 and December 2021 and their recipients were retrospectively reviewed. Among these, 541 patients underwent pure laparoscopic donor right hepatectomy (PLDRH). The mean hospital stay of the donor was 7.2 days, and the rate of grade I, II, IIIa, and IIIb complications was 2.2%, 2.7%, 1.3%, and 0.9%, respectively, without any irreversible disabilities or mortalities. The most common early and late major complications in the recipient were intraabdominal bleeding (n = 47, 8.5%) and biliary problems (n = 198, 35.6%), respectively. Analysis of the PLDRH procedure showed that operative time, liver removal time, warm ischemic time, Δhemoglobin%, Δtotal bilirubin%, and postoperative hospital stay decreased significantly as the number of cases accumulated. In conclusion, the operative outcomes of PLDRH improved as the number of cases increased. However, continuous caution is needed because major complications still occur in donors and recipients even after hundreds of cases.

Outcomes of pure laparoscopic donor hepatectomy for a right lobe graft weighing more than 1,000 g

Suk Kyun Hong, Minseob Kim, Youngjin Kim, Jaeyoon Kim, Hyun Hwa Choi, Jaewon Lee, Jiyoung Kim, Su young Hong, Jeong-Moo Lee, YoungRok Choi, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh. Ann Liver Transplant -0001;0:. https://doi.org/10.52604/alt.23.0010

Early experience with pure laparoscopic donor hepatectomy: comparison with open donor hepatectomy and non-donor laparoscopic hepatectomy.

Pure laparoscopic donor hepatectomy (L-DH) has seen a rise in uptake in recent years following the popularization of minimally invasive modality for major hepatobiliary surgery. Our study aimed to determine the safety and compare the perioperative outcomes of L-DH with open donor hepatectomy (O-DH) and laparoscopic non donor hepatectomy (L-NDH) based on our single institution experience. Eighty of 113 laparoscopic hemi-hepatectomies performed between 2015 and 2022 met study inclusion criteria. Of these, 11 were L-DH. PSM in a 1:2 ratio of L-DH versus L-NDH and 1:1 ratio of L-DH versus O-DH were performed, identifying patients with similar baseline clinicopathological characteristics. After 2:1 matching, the L-DH cohort were significantly younger (P < 0.001) and had lower ASA scores (P < 0.001) than the L-NDH cohort. L-DH was associated with a longer median operating time (P < 0.001) and shorter median postoperative stay (P < 0.001) than L-NDH. After 1:1 matching, there were no significant differences in baseline demographic between the L-DH and O-DH cohorts. L-DH was associated with lower median blood loss (P = 0.040) and shorter length of stay compared to O-DH (P = 0.004). There were no significant differences in recipient outcomes for both cohorts. L-DH can be adopted safely by surgeons experienced in L-NDH and ODH. It is associated with decreased blood loss and shorter length of stay compared to O-DH.

Pure Laparoscopic Donor Left Hepatectomy Reduces Postoperative Analgesic Use and Pain Scale

BackgroundMany recent reports have described the efficacy and safety of pure laparoscopic donor hepatectomy (PLDH). Here we investigated the extent to which this technique could reduce patients’ experienced pain. MethodsAmong donor left hepatectomy procedures performed between July 2011 and November 2022, we retrospectively analyzed 20 open donor hepatectomy (ODH), 20 laparoscopy-assisted donor hepatectomy (LADH), and 5 PLDH cases. We compared these 3 procedures regarding the total amount of postoperative analgesic use (narcotics and non-narcotics) and the first date when the donor was completely pain-free, as evaluated by the patients using a pain scale. ResultsTotal postoperative fentanyl use did not significantly differ among the 3 procedures: median (range), ODH, 0.5 mg (0-2 mg); LADH 1.2 mg (0-7 mg); PLDH, 0.5 mg (0-3.5; P = .172). The percentage of patients who completely discontinued analgesics on postoperative day (POD) 5 was significantly higher for PLDH (80%) than for ODH (35%) or LADH (20%) (P = .041). The day when 50% of donors were completely pain-free on a pain scale was POD9 for ODH, POD11 for LADH, and POD5 for PLDH, significantly shorter in the PLDH group (P = .004). ConclusionAt our institution, we found that PLDH was a useful technique for postoperative pain management compared with PDH and LADH. Our results suggest that PLDH effectively reduces the duration of postoperative analgesia use. Further studies are warranted as the number of PLDH cases gradually increases.

Initial outcome of external biliary drainage in living donor liver transplantation with pure laparoscopic donor hepatectomy.

Biliary complications after living donor liver transplantation (LDLT) are the most common and intractable complications due to both surgical and nonsurgical factors. External biliary drainage (EBD), a surgical option to prevent biliary complications, has recently been adopted in the era of pure laparoscopic donor right hepatectomy, which may result in increased bile duct problems in the recipients. This study retrospectively reviewed the patients who underwent LDLT with duct-to-duct anastomosis between July 2017 and October 2020 to analyze the initial outcomes of EBD and to compare the incidence of biliary complications in adult LDLT recipients who underwent duct-to-duct anastomosis with or without EBD. Only patients who underwent pure laparoscopic donor hepatectomy were included in this study. The patients were divided into 2 groups according to the application of EBD. The median follow-up period was 28.5 months. The overall incidence of Clavien-Dindo grade IIIa biliary complications was 35.0% (n=14) in the EBD group and 50.7% (n=76) in the non-EBD group ( p = 0.08). The incidence of biliary leakage was 0% in the EBD group and 15.3% in the non-EBD group ( p = 0.01). The EBD-related complication rate, that is, involving retraction, accidental removal, and dislocation, was 40.0%. EBD implementation is effective in preventing biliary leakage after LDLT with a graft procured using the pure laparoscopic donor right hepatectomy method with duct-to-duct biliary anastomosis. However, efforts should be made to prevent EBD-related complications. Further studies are needed to establish appropriate selection criteria for EBD.

Artificial intelligence-guided bile duct division during pure laparoscopic donor hepatectomy

Artificial intelligence-guided bile duct division during pure laparoscopic donor hepatectomy

Safety of pure laparoscopic donor hepatectomy for adult living donor liver transplant: comparison with laparoscopic non-donor hepatectomy

Safety of pure laparoscopic donor hepatectomy for adult living donor liver transplant: comparison with laparoscopic non-donor hepatectomy

Pure Laparoscopic Versus Open Right Hepatectomy in Living Liver Donors: Graft Weight Discrepancy.

BACKGROUND Accurate volumetric evaluation of donors' livers before surgery is crucial for successful living-donor liver transplantation. However, there are few studies on the volumetric evaluation in the recently popularized pure laparoscopic donor hepatectomy method, in contrast to the number of studies for conventional donor hepatectomy. We aimed to analyze the difference between estimated graft weight and actual graft weight in pure laparoscopic donor right hepatectomy (PLDRH) and conventional donor right hepatectomy (CDRH) procedures. MATERIAL AND METHODS The medical records of 612 donors who underwent right hepatectomy in living-donor liver transplantation between January 2014 and December 2020 were retrospectively reviewed. The CDRH group targeted patients from January 2014 to October 2015, and the PLDRH group targeted patients from March 2016 to December 2020. RESULTS There were 119 and 376 donors who underwent CDRH and PLDRH, respectively. Although there was no significant difference in the estimated graft weights (P=0.994) and actual graft weights (P=0.489) between the groups, the estimated graft weights were significantly higher than the actual graft weights in both groups. However, the estimated graft weight and actual graft weight showed linear correlations in both the CDRH (r=0.81, P<0.001) and PLDRH (r=0.76, P<0.001) groups, with the CDRH group having greater linearity. CONCLUSIONS The estimates of graft weight were similar between the 2 groups. However, since the actual graft weight tended to be smaller in the PLDRH group, this should be considered before surgery.

244.6: Postoperative Health Status and Quality of Life After Pure Laparoscopic Donor Hepatectomy for Living Donor Liver Transplantation

Background: Laparoscopic donor hepatectomy (LDH) for living donor liver transplantation has been performed in several specialized institutes. Surgical outcomes of LDH have shown comparable results to open donor hepatectomy (ODH), but the quality of life (QOL) after LDH is not known. This prospective questionnaire-based study was performed to assess health status and QOL of live liver donors before and after donor hepatectomy (DH). Material and Methods: From May 2017 to February 2020, 70 liver donors who underwent donor hepatectomy (DH) were enrolled, and questionnaire items such as Enhanced Recovery after Surgery (ERAS) mobility scale (EMS), Body Image Questionnaire (BIQ), and EQ-5D-3L were examined up to one year after DH to evaluate postoperative recovery, body image satisfaction, and health status, respectively. During the study period, 45 LDH donors and two ODH donors were finally fully evaluated (Figure 1). Results: Two patients in the OLH group were discharged on POD 8 and POD 10, respectively, with neither of the two achieving the level of being independently mobile (EMS ≥8). On the contrary, patients in the LDH group were considered independently mobile from POD 5 based on the mean EMS of 45 patients. The LDH group had a significantly higher mean EMS than the ODH group on POD 5 and 7 (P = 0.011, and P = 0.004, respectively, Figure 2). Body image score of the LDH group was significantly higher than that of the ODH group at one month after DH (17.8 vs. 15.0, P = 0.017). EQ-5D-3L index value and EQ-5D-3L VAS were not different from preoperative values at six months (P = 0.059) and one month (P = 0.217), respectively (Figure 3). Conclusions: Donors undergoing LDH showed faster (within a month) mobility recovery and body image satisfaction to the level of preoperative status than donors undergoing ODH. In the evaluation of QOL using EQ-5D, donors who underwent LDH recovered to preoperative health status within six months, in accordance with previous studies of donors with ODH. A multicentre prospective study will be needed to compare the LDH and ODH groups.

Postoperative health status and quality of life after pure laparoscopic donor hepatectomy for living donor liver transplantation

Postoperative health status and quality of life after pure laparoscopic donor hepatectomy for living donor liver transplantation

Postoperative Health Status and Quality of Life After Pure Laparoscopic Donor Hepatectomy for Living Donor Liver Transplantation.

BackgroundLaparoscopic donor hepatectomy (LDH) for living donor liver transplantation has been performed in several specialized institutes. Surgical outcomes of LDH have shown comparable results to open donor hepatectomy (ODH), but the quality of life (QOL) after LDH is not known. This prospective questionnaire-based study was performed to assess health status and QOL of live liver donors before and after donor hepatectomy (DH).Material/MethodsFrom May 2017 to February 2020, questionnaire items such as the Enhanced Recovery after Surgery mobility scale (EMS), Body Image Questionnaire, and EQ-5D-3L were examined up to 1 year after DH to respectively evaluate postoperative recovery, body image satisfaction, and health status.ResultsDuring the study period, 45 laparoscopic DH (LDH) donors and 2 open DH (ODH) donors were finally fully evaluated. The LDH group had a significantly higher mean EMS than ODH on postoperative day (POD) 5, and 7 (P=0.011, and P=0.004, respectively). Body image scores of the LDH group were significantly higher than that of the ODH group at 1 month after DH (17.8 vs 15.0, P=0.017). There were 45 LDH donors who recovered to preoperative values at 6 months and 1 month after DH, with no statistically significant difference in EQ-5D-3L index value and visual analogue scale (P=0.059 and P=0.217, respectively).ConclusionsWithin 1 month after DH, LDH donors showed faster mobility recovery and body image satisfaction to the level of preoperative status than ODH. LDH donors recovered to preoperative health status within 6 months, in accordance with previous studies of ODH donors.

Initial Experience of 60 Cases Pure-Laparoscopic Donor Hepatectomy in Cleveland Clinic

Introduction: The adoption of pure-laparoscopic donor hepatectomy (PLDH) has been slow in North America because of the associated technical complexity and concerns for donor safety. This study aimed to report our initial 60 PLDH and elaborate on the understanding of the pre-requisites for the successful introduction of PLDH. Method: Retrospective review during the initial 2 years after the introduction Results: Between August 2019 and August 2021, 60 PLDH were performed; 33 patients donated left lobe grafts, 25 cases were right lobe grafts, 1 case was right posterior section graft, and 1 patient donated left lateral segment. The characteristics of 60 PLDH were summarized in Table. The median operative time was 345 minutes in the left lobe group and 348 minutes in the right lobe group, respectively. No cases required intraoperative blood transfusion or open conversion. Two patients developed a postoperative surgical wound infection, one patient required postoperative blood transfusion, one patient required laparoscopic portal vein venoplasty for portal vein stenosis. The median in-patient stay was 5 days (4-9) and there were no 30-day readmissions. Conclusions: Seamless introduction of OLDH and donor safety were achieved by: 1) minimizing the learning curve through proctorship from experienced surgeon, 2) establish a dedicated surgical team and accumulate adequate surgical experience in living donor hepatectomy and laparoscopic hepatectomy, especially major hepatectomy, 3) active institutional support to have proper instrumentation necessary for operational efficiency, and 4) proper master planning including the ready availability of a crisis management protocol and team in case of an emergency.Tabled 1Left Lobe (N=33, 55.0%)Right lobe (N=25, 41.7%)Age34 (18-58)43 (25-58)male/Female22/117/18Height178 (158-196)168 (155-189)Weight82 (61-119)76 (54-122)BMI27.6 (21.3-36.6)27.7 (21.3-39.7)Operative time345 (256-501)348 (264-450)EBL200 (50-600)150 (30-500)Complicatio33LOS5 (4-8)5 (4-9) Open table in a new tab

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.

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.