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Laparoscopic Living Donor Left Lateral Sectionectomy: A New Standard Practice for Donor Hepatectomy
Olivier Soubrane1, Olivier de Rougemont, Ki-Hun Kim
1*Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, France †University Denis Diderot, Paris, France ‡Swiss HPB and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland §Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea ¶Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY ||Department of Transplantation, Guy's Hospital, London, UK **Department of Liver Transplant, Hôpital Edouard Herriot, Lyon, France ††Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium ‡‡Department of Surgery, Hôpital La Pitié, University Pierre et Marie Curie, Paris, France §§Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France ||||University Paris Sud, Paris, France.
Objective:
The aim of the study was to compare the short-term donor outcomes of laparoscopic left lateral sectionectomy (LLLS) for adult to child living donor liver transplantation (A-C LDLT) and laparoscopic donor nephrectomy (LDN).
Background:
Although laparoscopy has become the standard approach in kidney donors, its use remains limited and controversial in LLS for A-C LDLT due to the lack of conclusive assessment of procedure-related morbidity.
Methods:
From 2001 to 2014, 124 healthy donors undergoing laparoscopic LLLS for A-C LDLT at 5 tertiary referral centers in Europe, North America, and Asia, and 300 healthy donors undergoing LDN at 2 tertiary centers in Europe were retrospectively analyzed. The outcomes of LLLS were compared with those of LDN including the use of the comprehensive complication index (CCI).
Results:
Although liver donors experienced significantly less overall (16.9% vs 31.7%, P = 0.002) and grade 1 to 2 (12.1% vs 24.7%, P = 0.004) complications than kidney donors, the rates of major complication (≥ grade 3) were similar between the 2 groups. In both groups, donors experiencing postoperative complications had similar CCI (19.3 vs 21.9 for liver and kidney donors, respectively, P = 0.29). After propensity score analysis allowing for matching donors on age, sex, and body mass index, the postoperative outcomes remained comparable between the 2 groups.
Conclusion:
Laparoscopic LLS for A-C LDLT yields at least similar short-term donor outcomes as LDN. These results provide the first validation for a laparoscopic donor hepatectomy and suggest that the laparoscopic approach should be considered a new standard practice for retrieval of left lateral section liver grafts as it is for kidney donation.
