From the left to the right: 13-year experience in laparoscopic living donor liver transplantation

Living Donors are the best theoretical candidates to benefit from the advantages of laparoscopy, but development was slow because of concerns about graft integrity and donor safety. Herein our 13-year experience in laparoscopic Living Donor Liver Transplantation (LDLT) is presented. Laparoscopic Left Lateral Section (LLLS) was performed in children receiver, while Laparoscopic Left Hepatectomy (LLH)-including or not the middle hepatic vein-and Laparoscopic Right Hepatectomy (LRH) in adults. Two senior surgeons were always involved for each procedure. All donors were first-degree relatives. From 2001 to 2014, 71 procedures were performed: 63 LLLS (88.7%, 6 LLH (8.4%), and 2 LRH (2.8%). Surgical procedures required a mean of 271.1 ± 65.9, 318 ± 40.2, and 480 ± 0 min for LLLS, LLH, and LRH, respectively with a learning curve toward LLLH over the years (r = 0.09). Seven procedures (9.8%) required conversion. The mean hospital stay was 5.5 ± 3.4, 5.3 ± 0.6, and 8 ± 0 days for LLLS, LLH, and LRH, respectively. Complications occurred in 11 patients (17.3%) undergoing LLLS: 8 (12.7%) grade I and 3 (4.7%) grade II, according to the Modified Clavien-Dindo classification. Laparoscopic liver resection for LDLT requires an equivalent and parallel expertise in open LDLT and LLR. If LLLS for LDLT is now in an exploration phase in highly specialized centers, LLH and LRH for LDLT in adults lack evidence and cannot be recommended for wide introduction. For laparoscopic LDLT beginners, LLLS offers optimal conditions.