Laparoscopic liver resection for living donation: where do we stand?

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Transplantation

Background:

• Living donor liver transplantation (LDLT) is an alternative to deceased donor transplantation but faces reluctance in Western countries due to complications.
• A laparoscopic approach may enhance patient tolerance and revive LDLT, but concerns about safety, graft integrity, surgical expertise, and evidence have delayed its adoption.

Purpose of the Study:

• To evaluate the feasibility and benefits of laparoscopic approaches in living donor liver transplantation.
• To compare laparoscopic versus open techniques for donor hepatectomy in LDLT.

Main Methods:

• Review of laparoscopic techniques for donor hepatectomy, including left lateral sectionectomy and major hepatectomies (right/left).
• Comparison of outcomes between laparoscopic and open approaches, focusing on donor safety, graft quality, and hospital stay.

Main Results:

• Laparoscopic left lateral sectionectomy for adult-to-child LDLT is standardized, showing decreased donor blood loss, shorter hospital stays, and comparable graft quality to open surgery.
• Laparoscopic major hepatectomies for adult-to-adult LDLT lack standardization, with various techniques reported (full laparoscopic, hand-assisted, hybrid).

Conclusions:

• Laparoscopic techniques are feasible for LDLT, particularly for pediatric donations.
• Further standardization and international registries are needed to fully assess the benefits of laparoscopic major hepatectomies over open surgery in adult LDLT.