Ann Surg Treat Res.  2022 Jul;103(1):40-46. 10.4174/astr.2022.103.1.40.

Pure laparoscopic versus open right donor hepatectomy including the middle hepatic vein: a comparison of outcomes and safety

Affiliations
  • 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea

Abstract

Purpose
Analyses on pure laparoscopy in donor hepatectomies, including the middle hepatic vein (MHV), are still scarce. This study aimed to compare the outcomes of donor right hepatectomy, including the MHV, when performed laparoscopically with conventional open surgery.
Methods
Data from living donors who underwent donor right hepatectomy between January 2012 and December 2020 were retrospectively analyzed. The intraoperative and postoperative complication rates of the pure laparoscopic donor right hepatectomy (PLDRH) with MHV inclusion (PLDRHM) group were compared with the conventional open donor right hepatectomy with MHV inclusion (CDRHM) group and the PLDRH without MHV inclusion [PLDRHM(–)] group.
Results
Compared to the CDRHM group, the PLDRHM group had a longer bench time (P < 0.001) and higher Δ%,calculated as [(preoperative value – postoperative value)/preoperative value] × 100, of AST (P < 0.001), ALT (P < 0.001), and total bilirubin (P = 0.023), but shorter hospital stay (P = 0.004) and a lower rate of complications (P = 0.005). Compared to the PLDRHM(–) group, the PLDRHM group had fewer male donors (P < 0.001) and a lower body mass index (P < 0.001), estimated total liver volume (P < 0.001), and real graft weight (P < 0.001). Results of laboratory changes, hospital stays, and complication rates were similar between the 2 groups.
Conclusion
PLDRH with the inclusion of the MHV in selected donors and recipients is feasible and safe when performed by surgeons experienced in laparoscopic surgery, with favorable complication rates compared to CDRHM and PLDRHM(–).

Keyword

Hepatectomy; Laparoscopy; Liver transplantation

Figure

  • Fig. 1 Study design. MHV, middle hepatic vein; CDRHM, conventional open donor right hepatectomy with MHV inclusion; PLDRHM, pure laparoscopic donor right hepatectomy with MHV inclusion; PLDRHM(–), pure laparoscopic donor right hepatectomy without MHV.


Reference

1. Korolija D, Sauerland S, Wood-Dauphinée S, Abbou CC, Eypasch E, Caballero MG, et al. Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc. 2004; 18:879–897. PMID: 15108103.
Article
2. Lee JM, Shehta A, Lee KW, Hong SK, Cho JH, Yi NJ, et al. Donor wound satisfaction after living-donor liver transplantation in the era of pure laparoscopic donor hepatectomy. Surg Endosc. 2021; 35:2265–2272. PMID: 32430524.
Article
3. Gao Y, Wu W, Liu C, Liu T, Xiao H. Comparison of laparoscopic and open living donor hepatectomy: a meta-analysis. Medicine (Baltimore). 2021; 100:e26708. PMID: 34397873.
4. Berglund D, Kirchner V, Pruett T, Mangalick S, Kandaswamy R, Serrano OK, et al. Complications after living donor hepatectomy: analysis of 176 cases at a single center. J Am Coll Surg. 2018; 227:24–36. PMID: 29555562.
Article
5. Cherqui D, Soubrane O, Husson E, Barshasz E, Vignaux O, Ghimouz M, et al. Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet. 2002; 359:392–396. PMID: 11844509.
Article
6. Han HS, Cho JY. Total laparoscopic right liver donor hepatectomy. Seoul: Korean Liver Transplant Society;2012.
7. Rotellar F, Pardo F, Benito A, Martí-Cruchaga P, Zozaya G, Lopez L, et al. Totally laparoscopic right-lobe hepatectomy for adult living donor liver transplantation: useful strategies to enhance safety. Am J Transplant. 2013; 13:3269–3273. PMID: 24266975.
Article
8. Suh KS, Hong SK, Lee KW, Yi NJ, Kim HS, Ahn SW, et al. Pure laparoscopic living donor hepatectomy: focus on 55 donors undergoing right hepatectomy. Am J Transplant. 2018; 18:434–443.
Article
9. Hong SK, Lee KW, Choi Y, Kim HS, Ahn SW, Yoon KC, et al. Initial experience with purely laparoscopic living-donor right hepatectomy. Br J Surg. 2018; 105:751–759. PMID: 29579333.
Article
10. Lapisatepun W, Hong SK, Hong K, Han ES, Lee JM, Yi NJ, et al. Influence of large grafts weighing ≥ 1000 g on outcome of pure laparoscopic donor right hepatectomy. J Gastrointest Surg. 2021; 25:1980–1988. PMID: 33104954.
Article
11. Zhang W, Xu L, Zhang J, Che X. Safety and feasibility of laparoscopic living donor right hepatectomy for adult liver transplantation: a meta-analysis. HPB (Oxford). 2021; 23:344–358. PMID: 33281079.
Article
12. Lo CM, Fan ST, Liu CL, Lo RJ, Lau GK, Wei WI, et al. Extending the limit on the size of adult recipient in living donor liver transplantation using extended right lobe graft. Transplantation. 1997; 63:1524–1528. PMID: 9175822.
Article
13. de Villa VH, Chen CL, Chen YS, Wang CC, Lin CC, Cheng YF, et al. Right lobe living donor liver transplantation-addressing the middle hepatic vein controversy. Ann Surg. 2003; 238:275–282. PMID: 12894022.
Article
14. Kido M, Ku Y, Fukumoto T, Tominaga M, Iwasaki T, Ogata S, et al. Significant role of middle hepatic vein in remnant liver regeneration of right-lobe living donors. Transplantation. 2003; 75:1598–1600. PMID: 12792523.
Article
15. Dayangac M, Taner CB, Balci D, Memi I, Yaprak O, Akin B, et al. Use of middle hepatic vein in right lobe living donor liver transplantation. Transpl Int. 2010; 23:285–291. PMID: 19821954.
Article
16. Cattral MS, Molinari M, Vollmer CM Jr, McGilvray I, Wei A, Walsh M, et al. Living-donor right hepatectomy with or without inclusion of middle hepatic vein: comparison of morbidity and outcome in 56 patients. Am J Transplant. 2004; 4:751–757. PMID: 15084170.
Article
17. Hong SK, Suh KS, Kim KA, Lee JM, Cho JH, Yi NJ, et al. Pure laparoscopic versus open left hepatectomy including the middle hepatic vein for living donor liver transplantation. Liver Transpl. 2020; 26:370–378. PMID: 31808294.
Article
18. Hong SK, Lee KW, Kim HS, Yoon KC, Ahn SW, Choi JY, et al. Optimal bile duct division using real-time indocyanine green near-infrared fluorescence cholangiography during laparoscopic donor hepatectomy. Liver Transpl. 2017; 23:847–852. PMID: 27935193.
Article
19. Hong K, Hong SK, Han ES, Suh S, Hong SY, Lee JM, et al. Pure laparoscopic vs. open right hepatectomy in living liver donors: bench-surgery time. Front Surg. 2021; 8:771026. PMID: 34888346.
Article
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