Total laparoscopic living donor right hemihepatectomy: first case in China mainland and literature review

Abstract

Background: Total laparoscopic living donor right hemihepatectomy (LDRH) has been performed in several experienced transplant center [1-4]. We here report the first case of LDRH in China mainland and literature review.

Methods: A 47-year-old man volunteered for living donation to his wife who suffered sclerosing cholangitis-related liver cirrhosis and hepatocellular carcinoma.

Results: Donor height is 165 cm and weight is 65 kg, while the BMI is 23.9. Preoperative liver function tests were normal. The CT volume evaluation showed that the graft to body weight ratio (GBWR) was 1.42 % and the remnant liver volume was 36.3 % for right graft without middle hepatic vein. Biopsy result showed minimal steatosis. The anatomy of hepatic vein, artery, portal vein and bile duct was normal. A transection was performed along the cut line which was to the right side of middle hepatic vein. Two branches of the middle hepatic vein (Segment V and Segment VIII) were <5 mm in diameter, with no need of reconstruction. Hilar dissection was meticulously performed. Right portal vein, hepatic artery and bile duct were transected above the bifurcation. The right liver graft was placed in a retrieval bag and removed from suprapubic incision. The real graft volume was 660 ml with a revised GBWR of 1.14 %. Warm ischemia time was about 4 min. The postoperative course was uneventful for the donor. Literature review is shown in Table 1.

Conclusion: Total LDRH has been demonstrated technically feasible in selected adult donors. It may be a safe and minimally invasive option for adult donors in experienced transplant center.

Keywords: Laparoscopy; Living donor liver transplantation; Right hemihepatectomy.