Laparoscopic living donor hepatectomy: a review of current status

Abstract

Over the last two decades, laparoscopic surgery has been adopted in various surgical fields. Its advantages of reduced blood loss, reduced postoperative morbidity, shorter hospital stay, and excellent cosmetic outcome compared with conventional open surgery are well validated. In comparison with other abdominal organs, laparoscopic hepatectomy has developed relatively slowly due to the potential for massive bleeding, technical difficulties and a protracted learning curve. Furthermore, applications to liver graft procurement in living donor liver transplantation (LDLT) have been delayed significantly due to concerns about donor safety, graft outcome and the need for expertise in both laparoscopic liver surgery and LDLT. Now, laparoscopic left lateral sectionectomy in adult-to-pediatric LDLT is considered the standard of care in some experienced centers. Currently, the shift in application has been towards left lobe and right lobe graft procurement in adult LDLT from left lateral section in pediatric LDLT. However, the number of cases is too small to validate the safety and reproducibility. The most important concern in LDLT is donor safety. Even though a few studies reported the technical feasibility and comparable outcomes to conventional open surgery, careful validating through larger sample sized studies is needed to achieve standardization and wide application.

Survey Results of the Expert Meeting on Laparoscopic Living Donor Hepatectomy and Literature Review

“…Although the numbers of cases investigated were too small to validate the safety and reproducibility of laparoscopic donor left hepatectomy, there have been consistent attempts to reduce donor morbidity, and this technique provides a good option for laparoscopic donor hepatectomy in adult LDLT. On the other hand, some authors prefer using the right lobe graft to ensure recipient recovery [15,16].…”

Use of robotics in liver donor right hepatectomy

“…Following the first laparoscopy-assisted donor right hepatectomy reported in 2006 (17), only a small number of selected donors with favorable anatomy were documented during the evolution of minimally invasive technique in the past decade ( Table 1) (19)(20)(21). Most reports regarding minimally invasive donor right hepatectomy were either hand-assisted procedure or were with high conversion and complication rates (24).…”

Protocol for laparoscopic cholecystectomy: Is it rocket science?

“…Compared with open surgery (OS), PLS has substantial advantages in terms of less blood loss, less pain, a lower morbidity rate, a shorter time to a postoperative diet, and a shorter hospital stay[1]. Unfortunately, especially in the field of hepatobiliary and pancreatic (HBP) surgery, PLS has developed relatively slowly due to technical difficulties and a protracted learning curve[1]. …”