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One Hundred Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center

Lee, Kwang-Woong, PhD, MD1; Hong, Suk Kyun, MD1; Suh, Kyung-Suk, PhD, MD1; Kim, Hyo-Sin, MD2; Ahn, Sung-Woo, MD3; Yoon, Kyung Chul, MD1; Lee, Jeong-Moo, MD1; Cho, Jae-Hyung, MD1; Kim, Hyeyoung, MD4; Yi, Nam-Joon, PhD, MD1

doi: 10.1097/TP.0000000000002229
Original Clinical Science—Liver

Background The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation.

Methods Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods.

Results During the initial period, 3 (2.6%) donors experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 minutes vs 344.4 minutes; P < 0.001) and hospital stay (7.3 days vs 8.3 days; P = 0.002) were significantly shorter during the more recent period. Also, Δhemoglobin (Hb)%, calculated as ΔHb% = [(preoperative Hb − postoperative Hb)/preoperative Hb] × 100 (14.9% vs 17.5%; P = 0.042), and Δaspartate aminotransferase (AST)%, calculated as ΔAST% = [(peak AST − preoperative AST)/preoperative AST] × 100 (1048.9% vs 1316.6%; P = 0.009), were significantly lower during the recent period.

Conclusions Pure laparoscopic donor right hepatectomy is both feasible and safe when performed at a center experienced in adult living donor liver transplantation. Performance of about 60 PLDRHs over 1 year is sufficient to standardize the procedure.

The authors present the largest series of fully laparoscopic living donor liver procurements to date. We are reaching a turning point beyond which this very difficult procedure may be accepted as the preferred approach over time.

1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

2 Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea.

3 Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea.

4 Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.

Received 10 January 2018. Revision received 3 March 2018.

Accepted 30 March 2018.

The study received no grant support.

The authors have no conflicts of interest to disclose.

K.-W.L. and S.K.H. contributed equally to this work as co-first authors.

K.-W.L. and S.K.H. participated in study design. K.-W.L., S.K.H., K.-S.S., H.-S.K., S.-W.A., K.C.Y., J.-M.L., J.-H.C., H.K., and N.-J.Y. performed the research. K.-W.L. and S.K.H. performed data analysis and wrote the article.

Correspondence: Kyung-Suk Suh, MD, PhD, Department of Surgery, Seoul National University College of Medicine, 101 Daehakro, Jongrogu, 03080, Seoul, Korea. (kssuh2000@gmail.com).

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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