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Totally Laparoscopic Right Hepatectomy for Living Donor Liver Transplantation: Analysis of a Preliminary Experience on 5 Consecutive Cases

Rotellar, Fernando MD, PhD; Pardo, Fernando MD; Benito, Alberto MD, PhD; Zozaya, Gabriel MD; Martí-Cruchaga, Pablo MD; Hidalgo, Francisco MD, PhD; Lopez, Luis MD, PhD; Iñarrairaegui, Mercedes MD, PhD; Sangro, Bruno MD, PhD; Herrero, Ignacio MD, PhD

doi: 10.1097/TP.0000000000001532
Original Clinical Science—Liver

Background The pure laparoscopic approach in right hepatectomy (LRH) for living donor liver transplantation (LDLT) is a controversial issue. Some authors have reported the procedure to be feasible but surgical outcomes and impact on short and long-term morbidity rates are yet to be determined. The aim of this study is to present the results of a preliminary 5 consecutive cases series of LRH for LDLT and to compare it with a successive cohort of open right hepatectomies (ORH) for LDLT.

Methods From May 2013 to October 2015, 5 consecutive donors underwent LRH for LDLT in our center. The previous last 10 ORH for LDLT were selected for comparison. Special care was taken to include all adverse events. Each patient's complications were graded with the Clavien-Dindo Classification and scored with the Comprehensive Complication Index.

Results All 5 consecutive donors completed a pure laparoscopic procedure. All allografts (open and laparoscopically procured) were successfully transplanted with no primary graft failures. Only 2 Clavien-Dindo Grade-I complications occurred in the LRH donors, while ORH donors had 10 Grade I, 2 Grade II and 1 Grade IIIa complications in the short term (<3 months). In the long term (6–12 months follow-up), LRH donors had a significant lower incidence of complications (Comprehensive Complication Index: 1.74; SD, 3891 vs 15.2 SD; 8.618; P = 0.006).

Conclusions In our experience, LRH for LDLT is a feasible procedure. Further comparative series may support our preliminary findings of reduced incidence and severity of complications as compared with the open approach.

The authors report their first series of laproscopic right lobe procurements. Going beyond single case reports experience is now being accumulated around the world to indicate that functional grafts can be recovered safely using highly successful techniques in carefully selected patients. Supplemental digital content is available in the text.

1 Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain.

2 Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.

3 Abdominal Radiology, Department of Radiology, University Clinic, University of Navarra, Pamplona, Spain.

4 Anesthesiology, University Clinic, University of Navarra, Pamplona, Spain.

5 Hepatology, Department of Internal Medicine, University Clinic, University of Navarra, Pamplona, Spain.

6 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.

Received 24 April 2016. Revision received 12 August 2016.

Accepted 23 September 2016.

The authors declare no funding or conflicts of interest.

The following criteria define each of the author's contributions to the study and manuscript: F.R., F.R., A.B., G.Z., P.M-C., F.H., L.L., M.I., B.S., I.H. contributed to design of the study. F.R., F.R., I.H. Contributed to acquisition of data. F.R., F.R., A.B., G.Z., P.M-C., F.H., L.L., M.I., B.S., I.H. contributed to analysis and interpretation of data. F.R., F.H., I.H. participated in drafting of the paper. F.R., F.R., A.B., G.Z., P.M-C., F.H., L.L., M.I., B.S., I.H. participated in revising the paper critically for important intellectual content. F.R., F.R., A.B., G.Z., P.M-C., F.H., L.L., M.I., B.S., I.H. gave final approval of the version to be published.

Correspondence: Fernando Rotellar, MD, PhD, Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, 31008 Spain. (frotellar@unav.es).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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