Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging during Laparoscopic Donor Hepatectomy

Abstract

Objective: To investigate the feasibility and safety of an alternative robotic living-donor right hepatectomy (RLDRH) technique. Background data: Data for minimally invasive livingdonor right hepatectomy, especially RLDRH, in a relatively large donor cohort have not been reported yet. Methods: From March 2016 to March 2019, 52 liver donors underwent RLDRH. The clinical and perioperative outcomes of RLDRH were compared with those of conventional open donor right hepatectomy (CODRH; n=62) and laparoscopy-assisted donor right hepatectomy (LADRH; n=118). Donor satisfaction with cosmetic results was compared between RLDRH and LADRH using a body image questionnaire. Results: Although RLDRH had a longer operative time (RLDRH, 493.6 min; CODRH, 404.4 min; LADRH, 355.9 min, p< 0.001), its mean estimated blood loss was significantly lower (RLDRH, 109.8 mL; CODRH, 287.1 mL; LADRH, 265.5 mL; p< 0.001). The postoperative complication rates were similar among the three groups (RLDRH, 23.1%; CODRH, 35.5%; LADRH, 28.0%; p=0.420). Regarding donor satisfaction, the body image and cosmetic appearance scores were significantly higher in RLDRH than in LADRH. There was no significant difference in hospital stay among the three groups (p=0.105). After propensity score matching, RLDRH showed a shorter hospital stay and similar complication rate than CODRH. Conclusions: RLDRH resulted in a similar postoperative complication rate and shorter length of hospital stay compared with those of CODRH and provided better body image and cosmetic results compared with those of LADRH. RLDRH is feasible and can be safely performed by expert surgeons in both robotic systems and open hepatectomy.