Upper midline incision for living donor right hepatectomy

Area of Science:

• Surgical Innovation
• Transplant Surgery
• Hepatobiliary Surgery

Background:

• Traditional abdominal incisions for living donor right hepatectomy (LDRH) have seen limited evolution.
• Standard J-shaped incisions are commonly used but may be associated with significant postoperative pain.

Purpose of the Study:

• To introduce and evaluate the efficacy and safety of an upper midline incision for standard open LDRH.
• To compare outcomes of LDRH using an upper midline incision versus a conventional J-shaped incision.

Main Methods:

• A prospective case-matched study involving 23 donors undergoing LDRH with an upper midline incision (I group).
• Donors were matched 1:1 to 23 controls with a J-shaped incision (J group) based on age, gender, and BMI.
• Outcomes including operative time, blood transfusion, complications, and postoperative pain were assessed.

Main Results:

• LDRH was successfully completed in all 23 donors in the I group using a mean 13.5 cm upper midline incision.
• The I group demonstrated a shorter operative time and reduced analgesic use compared to the J group.
• Postoperative complications were minimal, with no blood transfusions required, and donors fully recovered.

Conclusions:

• The upper midline incision is a safe, reproducible, and effective approach for open LDRH.
• This technique offers benefits of reduced pain and potentially shorter recovery, making it a viable option for transplant centers.
• Further adoption of this minimally invasive approach in living donor liver transplantation is recommended.