J Minim Invasive Surg.  2019 Jun;22(2):61-68. 10.7602/jmis.2019.22.2.61.

A Single Center Experience for a Feasibility of Totally Laparoscopic Living Donor Right Hepatectomy

• Lee SK
• Han YS
• Ha H
• Han J
• Chun JM

• KMID: 2450259
• DOI: http://doi.org/10.7602/jmis.2019.22.2.61

Abstract

PURPOSE
Donor safety is the most important problem of living donor liver transplantation (LDLT). Although laparoscopic liver resection has gained popularity with increased surgical experience and the development of laparoscopes and specialized instruments, a totally laparoscopic living donor right hepatectomy (LDRH) technique has not been investigated for efficacy and feasibility. We describe the experiences and outcomes associated with LDRH in adult-to-adult LDLT in order to assess the safety of the totally laparoscopic technique in donors.
METHODS
Between May 2016 and July 2017, we performed hepatectomies in 22 living donors using a totally laparoscopic approach. Among them, 20 donors underwent LDRH. We retrospectively reviewed the medical records to ascertain donor safety and the reproducibility of LDRH; intra-operative and post-operative results including complications were demonstrated after performing LDRH.
RESULTS
The median donor age was 29 years old and the median body mass index was 22.6 kg/m2. The actual graft weight was 710 g and graft weight/body weight (GRWR) was 1.125. No donors required blood transfusion, conversion to open surgery, or reoperation. The postoperative mortality was nil and postoperative complications were identified in two donors. One had fluid collection in the supra-pubic incision site for graft retrieval and the second had a minor bile leakage from the cutting edge of the right hepatic duct stump. All the liver function tests returned to normal ranges within one month.
CONCLUSION
LDRH is a feasible operation owing to low blood loss and few complications. However, LDRH can be initially attempted after attaining sufficient experience in laparoscopic hepatectomy and LDLT techniques.

Keyword

Laparoscopic right hepatectomy; Living liver donor; Living donor liver transplantation

MeSH Terms

Bile
Blood Transfusion
Body Mass Index
Conversion to Open Surgery
Hepatectomy*
Hepatic Duct, Common
Humans
Laparoscopes
Liver
Liver Function Tests
Liver Transplantation
Living Donors*
Medical Records
Mortality
Postoperative Complications
Reference Values
Reoperation
Retrospective Studies
Tissue Donors
Transplants