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Pure laparoscopic right hepatectomy of living donor is feasible and safe: a preliminary comparative study in China

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Abstract

Background

The adoption of laparoscopic techniques for living donor major hepatectomy has been controversial issue. The aim of this study is to present the preliminary experience of laparoscopic right hepatectomy in China.

Methods

All the donors receiving right hepatectomy for adult-to-adult living donor liver transplantation (LDLT) were divided into three groups: pure laparoscopic right hepatectomy (PLRH) group, hand-assisted right hepatectomy (HARH) group and open right hepatectomy (ORH) group. We compared the perioperative data and surgical outcomes of donors and recipients among three groups.

Results

From November 2001 to May 2017, 295 donors have received right hepatectomy for LDLT in our center. Among them, 7 donors received PLRH, 26 donors received HARH and 262 donors received ORH. The operation time of PLRH group (509.3 ± 98.9 min) was longer than that of the HARH group (451.6 ± 89.7 min) and the ORH group (418.4 ± 81.1 min, p = 0.003). The blood loss was the least in the PLRH group (378.6 ± 177.1 mL), compared with that in the HARH group (617.3 ± 240.4 mL) and that in the ORH group (798.6 ± 483.7 mL, p = 0.0013). The postoperative hospital stay was shorter in the PLRH group (7, 7–10 days) than that in the HATH group (8.5, 7.5–12 days) and ORH group (11, 9–14 days; p = 0.001). Only one donor had pleural effusion (Grade I) and another one experienced pulmonary infection (Grade II). One recipient (14.3%) in the PLRH group occurred hepatic venous stenosis.

Conclusions

Laparoscopic approaches for right hepatectomy contribute to less blood loss, better cosmetic satisfaction, less severe complications, and faster rehabilitation. PLRH is a safe and feasible procedure, which must be performed in highly specialized centers with expertise of both LDLT and laparoscopic hepatectomy, and requires a hybrid-to-pure stepwise development.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CUSA:

Cavitron ultrasonic surgical aspirator

EAD:

Early allograft dysfunction

GRWR:

Graft-to-recipient weight ratio

HARH:

Hand-assisted right hepatectomy

INR:

International normalized ratio

IQR:

Interquartile range

PS:

Propensity score

IRHV:

Inferior right hepatic vein

IVC:

Inferior vena cava

LDLT:

Living donor liver transplantation

MHV:

Middle hepatic vein

MRCP:

Magnetic resonance cholangiopancreatography

PHHF:

Post-hepatectomy hepatic failure

PLRH:

Pure laparoscopic right hepatectomy

POD:

Postoperative day

PRH:

Open right hepatectomy

RHA:

Right hepatic artery

RHD:

Right hepatic duct

RHV:

Right hepatic vein

RLV:

Remnant liver volume

RPV:

Right portal vein

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Acknowledgements

We acknowledged the China Liver Transplantation Register (http://www.cltr.org/) for supporting the data of this study.

Funding

The grant of this study was supported by National Natural Science Foundation of China, No. 81400636.

Author information

Author notes

  1. Jiu-Lin Song and Jian Yang contributed equally to this study and should share the co-first authors.

Authors and Affiliations

  1. Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China

    Jiu-Lin Song, Jian Yang, Hong Wu, Lu-Nan Yan, Tian-Fu Wen, Yong-Gang Wei & Jia-Yin Yang

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  1. Jiu-Lin Song
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Correspondence to Yong-Gang Wei or Jia-Yin Yang.

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Disclosures

Jiu-Lin Song, Jian Yang, Hong Wu, Lu-Nan Yan, Tian-Fu Wen, Yong-Gang Wei, and Jia-Yin Yang have no conflicts of interest to disclose.

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Song, JL., Yang, J., Wu, H. et al. Pure laparoscopic right hepatectomy of living donor is feasible and safe: a preliminary comparative study in China. Surg Endosc 32, 4614–4623 (2018). https://doi.org/10.1007/s00464-018-6214-0

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  • DOI: https://doi.org/10.1007/s00464-018-6214-0

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