Korean J Transplant.  2022 Nov;36(Supple 1):S376. 10.4285/ATW2022.F-5155.

Initial experience of pure laparoscopic living donor right hepatectomy by junior surgeon with external traction of the cystic duct: a safe and feasible method

• Woo Y
• Choi HJ
• Na GH
• Park H
• Choi Y
• You YK

• KMID: 2535228
• DOI: http://doi.org/10.4285/ATW2022.F-5155

Abstract

Background
Minimally invasive surgery has become the mainstream, laparoscopic major hepatectomy is gradually increasing with two consensus meetings. However, purely laparoscopic donor right hepatectomy (PLDRH) is still being performed carefully, because donor safety and quality grafts must be obtained. One of the thresholds is hilar dissection. The external traction of the cystic duct can be helpful for hilar dissection and duct division.
Methods
From March 2019 to December 2019, 86 patients underwent donor right hepatectomy except for 17 patients who used left graft. Forty of them underwent PLDRH and 46 of them underwent open hepatectomy. PLDRH was performed using flexible scope and five ports. The gallbladder was not divided from the liver bed for traction after only cutting the cystic duct and artery. After tying the cystic duct stump in a “round loop,” external traction was performed to the left side of the epigastric area. From the seventh patient with PLDRH, cystic duct traction method was used.
Results
Their mean age was 40.4±14.4 years and eight (50.0%) were female. The average body mass index was 22.8 kg/m ² 19.1–25.4 kg/m ² ) and the average graft volume was 778.8 mL (608–1,300 mL) The mean graft steatosis was 2.6%. The average operation time was 327.3 minutes (250–380 minutes) and the time from hepatic artery clamping to graft out was 18.9 minutes (11–31 minutes). There was no intraoperative transfusion and no open conversion in all patients. One duct stricture developed as a surgical complication which was treated with ERBD insertion and there was one spontaneous pneumothorax during the op-eration. There was no reoperation or readmission. Recipients also recovered well and there was a bile leak in one patient of the recipients.
Conclusions
PLDRH still remains a challenging procedure requiring important experiences in both laparoscopic liver surgery and open living donor right hepatectomy. External traction of the cystic duct may be helpful for PLDRH.