Comparison of perioperative outcomes between pure laparoscopic surgery and open right hepatectomy in living donor hepatectomy: Propensity score matching analysis

Abstract

Pure laparoscopic donor right hepatectomy (PLDRH) is not a standard procedure for living donor liver transplantation but is safe and reproducible in the hands of experienced surgeons. However, the perioperative outcomes of PLDRH have not been fully evaluated yet. We used propensity score matching to compare the perioperative complications and postoperative short-term outcomes of donors undergoing PLDRH and open donor right hepatectomy (ODRH). A total of 325 consecutive donors who underwent elective, adult-to-adult right hepatectomy were initially screened. After propensity score matching, all patients were divided into two groups: PLDRH (n = 123) and ODRH (n = 123) groups. Perioperative complications and postoperative outcomes were compared between the two groups. Postoperative pulmonary complications were significantly more common in the ODRH than in the PLDRH group (54.5 vs. 31.7%, P < 0.001). The biliary complications (leak and stricture) were higher in PLDRH group than in the ODRH group (8% vs. 3%), but it failed to reach statistical significance (P = 0.167). Overall, surgical complication rates were similar between the two groups (P = 0.730). The opioid requirement during the first 7 postoperative days was higher in the ODRH group (686 vs. 568 mg, P < 0.001). The hospital stay and time to the first meal were shorter in the PLDRH than in the ODRH group (P = 0.003 and P < 0.001, respectively). PLDRH reduced the incidence of postoperative pulmonary complications and afforded better short-term postoperative outcomes compared to ODRH. However, surgical complication rates were similar in both groups.Laparoscopic liver surgery has become widely accepted, affording many benefits including fewer overall complications, less blood loss, lower pain scores, better donor quality-of-life during the early postoperative period, and a shorter hospital stay, compared to open surgery 1-3 . As surgical techniques advanced over time, laparoscopic surgery for living donor liver transplantation (LDLT) became possible 2 . After the first successful reports of laparoscopic left lateral sectionectomy during adult-to-child LDLT in 2002 4 , many centers adopted the laparoscopic approach as the standard for living liver donors undergoing small graft resections 5,6 . However, the use of laparoscopic procedures to perform larger graft resections (such as right hepatectomies) was initially limited by technical complexities and the steep learning curve associated with the procedures. However, a series of laparoscopic right hepatectomies performed by experienced surgeons at living donor centers showed that the results open Scientific RepoRtS | (2020) 10:5314 | https://doi.

Laparoscopic liver resection: indications, limitations, and economic aspects

“…Results from a recent series of 412 minimally invasive donor hepatectomies being performed at 10 leading centers were comparable with those of benchmarking series of open standard donor hepatectomy with a morbidity below 10% (Dindo-Clavien 3-4) and no mortality [74]. A retrospective analysis of 123 pure laparoscopic donor right hepatectomies (PLDRH) confirmed similar complication rates to the open technique [75]. However, there was a trend towards more biliary complications (leak and stricture) compared with the open technique (n = 123) after propensity score matching.…”

Postoperative outcomes of purely laparoscopic donor hepatectomy compared to open living donor hepatectomy: a preliminary observational study

“…Our center has published several reports on our initial experience with PLDH [ 12 13 14 15 ]. Several studies have compared PLDH and OLDH in terms of postoperative outcomes for donors and recipients [ 16 17 18 ]. Those studies covered data from the initiation of the PLDH in 2013 at our hospital to the establishment of the PLDH program in 2017 or later.…”

Decreasing the operation time of living donor liver transplantation in the era of laparoscopic living donor hepatectomy

“…Major bleeding during transection will lead to volume resuscitation, which will eventually lead to more bleeding. Therefore, harmony between the surgical and anesthesiology teams is essential [9]. Improvement in surgical skills in laparoscopic surgery, which is reflected in decreasing operating times, has a positive impact on recipient surgery.…”