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Pure Laparoscopic Donor Hepatectomy: A Multicenter Experience.

Suk Kyun Hong¹, Gyu-Seong Choi, Jaryung Han

¹Department of Surgery Seoul National University HospitalSeoul National University College of Medicine Seoul Republic of Korea Department of Surgery Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea Department of SurgerySchool of Medicine Kyungpook National University, Kyungpook, National University Hospital Daegu Republic of Korea Division of Hepatobiliary Surgery and Liver TransplantationDepartment of SurgeryAsan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea Department of Surgery Seoul National University Bundang HospitalSeoul National University College of Medicine Seoul Republic of Korea Department of Surgery, Digestive Disease and Surgery Institute Cleveland Clinic Cleveland OH.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society

|July 18, 2020

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Pure laparoscopic donor hepatectomy (PLDH) is safe and effective, with low complication rates in over 500 cases. This study shows comparable outcomes to open surgery, supporting PLDH for liver donation.

Area of Science:

Hepatobiliary Surgery
Minimally Invasive Surgery
Transplantation Surgery

Background:

Pure laparoscopic donor hepatectomy (PLDH) is not yet standard practice due to limited studies.
This is the largest study to date, analyzing over 500 PLDH cases.

Purpose of the Study:

To present the outcomes of a large cohort of living liver donors undergoing PLDH.
To evaluate both donor and recipient outcomes after PLDH, including right and left hepatectomies.

Main Methods:

Retrospective analysis of 545 PLDH cases from 5 Korean centers (until June 2018).
Included analysis of donor complications, recipient outcomes, and surgical learning curves.
Pearson correlation analysis explored the relationship between surgery duration and cumulative experience.

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Main Results:

545 PLDH cases analyzed: 481 right hepatectomies, 25 left hepatectomies, 39 left lateral sectionectomies.
Only 1.8% of donors required open conversion; no donor mortality or irreversible disability.
Major complications occurred in 4.6% of donors; recipient early and late major complication rates were 20.2% and 32.5% respectively.

Conclusions:

PLDH demonstrates favorable early and late postoperative outcomes for both donors and recipients.
Surgical duration decreased with cumulative experience, indicating a learning curve effect.
While comparable to open surgery, further studies are needed to establish PLDH as a new standard practice.