Initial experience with purely laparoscopic living-donor right hepatectomy

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Organ Transplantation

Background:

• Concerns exist regarding purely laparoscopic donor right hepatectomy (PLDRH) versus open donor right hepatectomy.
• Surgeons accustomed to open surgery may face challenges with PLDRH.

Purpose of the Study:

• To describe technical tips and potential pitfalls in performing PLDRH.
• To provide guidance for surgeons transitioning to laparoscopic living donor hepatectomy.

Main Methods:

• Retrospective analysis of 26 PLDRH cases at Seoul National University Hospital (Dec 2015 - Jul 2017).
• Data collection focused on intraoperative events and postoperative complications.
• All procedures performed by a single, experienced open hepatectomy surgeon.

Main Results:

• No donor required intraoperative transfusion; two donors underwent reoperation.
• Complications included incorrect dissection planes, portal vein injury, bile duct stenosis, and arterial damage.
• Other issues involved remnant portal vein angulation, postoperative bleeding, and liver surface damage.

Conclusions:

• PLDRH requires adaptation due to different viewing angles and caudal views compared to open hepatectomy.
• Surgeons experienced in open procedures need specialized laparoscopic liver surgery training for PLDRH.
• Adjustments in technique are crucial for successful and safe PLDRH.