Laparoscopic donor hepatectomy

Abstract

Laparoscopic liver resection has been applied to treat most indications for liver resection during the past two decades. According to the literature, patient numbers have increased exponentially as a result, and surgical difficulty has increased as well. In expert centers, laparoscopic anatomical hemihepatectomy and major liver resection more than 3 segments have become the acceptable treatment. Moreover, with surgical innovations and accumulated experience, living donor liver transplantation has become an established treatment choice for patients on the transplant waiting list. It is even considered an inevitable choice in regions with limited access to organs from deceased donors. However, significant morbidity and rare but catastrophic mortality are associated with donor hepatectomy and remain major concerns. Therefore, to decrease the incidence of complications, a minimally invasive approach in donor hepatectomy was adopted in the early 2000s. Initially, a minimally invasive approach was used for left lateral sectionectomy for pediatric liver transplant, then for laparoscopy-assisted hemihepatectomy and pure laparoscopic/robotic right donor hepatectomy, and more recently, for adult living donor liver transplantation. The extent of procedure complexity and potential complications depends on the approach and the size of the graft to be harvested. Early results from expert teams have seemed promising in terms of shortened donor recovery and improved perioperative outcomes. However, the combination of these two highly sophisticated surgical procedures raise more concerns about donor safety, especially with regard to unexpected events during the operation. A high level of evidence is very difficult to achieve in this highly specialized surgical practice with limited penetration. Therefore, an international registry has been suggested to determine the risks and benefits before the use of laparoscopic right donor hepatectomy spreads.

Extreme living donation: A single center simultaneous and sequential living liver-kidney donor experience with long-term outcomes under literature review

“…Beginning with donor left lateral sector hepatectomy in 2002 by Cherqui et al (35), laparoscopic and other minimally invasive approaches are being used today for living liver donation. This seems feasible and safe when performed by a surgeon who is highly experienced in both laparoscopic and hepatobiliary surgery and with an experienced transplant team (36)(37)(38). According to recent consensus guidelines, living donor laparoscopic left lateral sector hepatectomy adult to child liver transplantation may be regarded as standard procedures, but it is still limited to few highly specialized centers.…”

Complications and outcomes of 890 living liver donor hepatectomies at a single center: risks of saving loved one’s life

“…Beginning with donor left lateral sector hepatectomy in 2002 by Cherqui et al (32), laparoscopic and other minimally invasive approaches are being used today. This seems feasible and safe when performed by a surgeon who is highly experienced in both laparoscopic and hepatobiliary surgery and with an experienced transplant team (33)(34)(35).…”

Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation

“…Due to the obvious superiority of the minimal invasive approach in left lateral donation 44,45 and the encouraging reports from Asian centers, 16,18,46,47 in 2018 a new initiative was launched to apply minimal invasive donor surgery also to donors of full right or full left lobes for adult recipients. The first approach was the laparoscopic assisted technique as described by the Chicago group which resulted in a significant increase in minimal invasive techniques for hemi‐liver donors in 2018.…”