Comparison of laparoscopic and open living donor hepatectomy

Abstract

Laparoscopic donor hepatectomy (LDH), accepted as a minimally invasive approach, has become increasingly popular for living donor liver transplant. However, the outcomes of LDH remain to be fully clarified when compared with open living donor hepatectomy. Thus, our meta-analysis was designed to assess the efficacy of laparoscopic in comparison with conventional open donor hepatectomy. The PubMed, Cochrane, and Embase electronic databases were searched to identify the articles concerning the comparison of the efficacy of laparoscopic versus open surgery in treatment of living donor liver transplantation updated to March, 2020. The main search terms and medical Subject Heading terms were: “living donor,” “liver donor,” “minimally invasive,” “laparoscopic surgery,” and “open surgery.” After rigorous evaluation on quality, the data was extracted from eligible publications. The outcomes of interest included intraoperative and postoperative results. The inclusion criteria were met by a total of 20 studies. In all, 2001 subjects involving 633 patients who received laparoscopic surgery and 1368 patients who received open surgery were included. According to the pooled result of surgery duration, the laparoscopic surgery was associated with shorter duration of hospital stay (MD = −1.07, 95% CI −1.85 to −0.29; P = .007), less blood loss (MD = −57.57, 95% CI −65.07 to −50.07; P < .00001), and less postoperative complications (OR = 0.61, 95% CI 0.44–0.85; P = .003). And the open donor hepatectomy achieved a trend of shorter operation time (MD = 30.31, 95% CI 13.93–46.69; P = .0003) than laparoscopic group. Similar results were found in terms of ALT ( P = .52) as well as the AST ( P = .47) peak level between the 2 groups. LDH showed the better perioperative outcomes as compared with open donor hepatectomy. The findings revealed that LDH may be a feasible and safe procedure for the living donor liver transplantation.

Advances in the surgical treatment of liver cancer

“…Laparoscopic hepatectomy has been adapted to donor LR for living donor LT at some facilities because of its improved safety. Gao et al (44) reported that a laparoscopic donor hepatectomy group (n = 633) had a longer operating time than an open living donor hepatectomy group (n = 1368) but shorter postoperative hospitalization, less blood loss, and fewer complications.…”

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“…55 Gao and associates reported similar results in their meta-analysis. 56 Peng and colleagues specifically compared pure laparoscopic donor right hepatectomy vs ODRH on a total of 1,940 patients from 6 studies in their meta-analysis. 57 They found that pure laparoscopic donor right hepatectomy had a longer operative time than ODRH, but lower overall morbidity (OR .67, 95% CI .45–.99, P = .04), fewer pulmonary complications (OR .47, 95% CI .29–.76, P = .002), and shorter hospital stays (weighted mean difference −1, P < .001) than ODRH.…”

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“…Even without serious complications, the large permanent abdominal scar following standard open surgery results in emotional and physical stress for some living donors, and particularly young women, possibly leading to hesitancy in undergoing donor hepatectomy. A recent meta-analysis reported that laparoscopic surgery was associated with a shorter duration of hospitalization, less blood loss, fewer postoperative complications, and a longer operating time than open surgery (30). Minimally invasive donor hepatectomy (MIDH) including laparoscopy-assisted hepatectomy, total laparoscopy hepatectomy, and indocyanine green fluorescence (ICG) image-guided total laparoscopic hepatectomy are becoming the main approaches of the future.…”