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. 2022 Feb 11;22(1):48.
doi: 10.1186/s12893-022-01507-0.

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

Worakitti Lapisatepun  1   2 , Sunhawit Junrungsee  3   4 , Anon Chotirosniramit  1   2 , Kanya Udomsin  1   2 , Warangkana Lapisatepun  2   5 , Phuriphong Chanthima  2   5 , Settapong Boonsri  2   5 , Suraphong Lorsomradee  2   5
Affiliations

Comparative outcomes of pure laparoscopic and open donor right hepatectomy: the first report from a Southeast Asian transplant center

Worakitti Lapisatepun et al. BMC Surg. .

Abstract

Background: Pure laparoscopic donor right hepatectomy (PLDRH) can provide better operative outcomes for the donor than conventional open donor right hepatectomy (CODRH). However, the complexity of the procedure typically makes transplant teams reluctant to perform it, especially in low-volume transplant centers. We compared the outcomes of PLDRH and CODRH to demonstrate the feasibility of PLDRH in a low-volume transplant program.

Methods: We carried out a retrospective study of adult living donor liver transplantation in Chiang Mai University Hospital from January 2015 to March 2021. The patients were divided into a PLDRH group and a CODRH group. Baseline characteristics, operative parameters, and postoperative complications of donors and recipients were compared between the two groups.

Results: Thirty patients underwent donor hepatectomy between the dates selected (9 PLDRH patients and 21 CODRH patients). The baseline characteristics of the 2 groups were not significantly different. The median graft volume of the PLDRH group was 693.8 mL, which was not significantly different from that of the CODRH group (726.5 mL) The PLDRH group had a longer operative time than the CODRH group, but the difference was not statistically significant (487.5 min vs 425.0 min, p = 0.197). The overall complication rate was not significantly different between the two groups (33.3% vs 22.2%, p = 0.555). Additionally, for the recipients, the incidence of major complications was not significantly different between the groups (71.3 vs 55.6%, p = 0.792).

Conclusion: Even in the context of this low-volume transplant program, whose staff have a high level of experience in minimally invasive hepatobiliary surgery, PLDRH showed similar results to CODRH in terms of perioperative outcomes for donors and recipients.

Keywords: Conventional open donor right hepatectomy; Indocyanine green; Living donor liver transplantation; Perioperative outcome; Pure laparoscopic donor right hepatectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient, surgical team and port positions
Fig. 2
Fig. 2
Vascular inflow identification and ischemic demarcation. a The right hepatic artery and right portal vein were wrapped with red and blue elastic tape, respectively, and then temporarily controlled with an endo-bulldog clamp. b Ischemic demarcation line demonstrated and marked by overlaid near-infrared imaging. c Laparoscopic ultrasound was used to identify the middle hepatic vein
Fig. 3
Fig. 3
Middle hepatic vein after parenchymal transection and ligation for preoperative planning
Fig. 4
Fig. 4
Real-time ICG cholangiogram-assisted bile duct division in pure laparoscopic donor right hepatectomy
Fig. 5
Fig. 5
Summary of strategy to develop PLDRH in low-volume transplant centers
See this image and copyright information in PMC

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