Abstract:Background
Total laparoscopic donor right hepatectomy (TLDRH) for adult living liver donors has been reported by a few experienced centers, but with limited cases, its safety and feasibility remain controversial. We report our experience initiating TLDRH using a stepwise approach to gradually convert laparoscopy‐assisted donor right hepatectomy (LADRH) to TLDRH.
Methods
We retrospectively analyzed the data of 61 LADRHs, 56 conventional open donor right hepatectomies (CODRHs), and 3 TLDRHs performed between Mar… Show more
“…Lastly, 15 studies were selected for a total of 2094 cases investigated. The MILR cases were 553 (26.4%), and the OLR 1,541 (73.6%) [ 16 – 30 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…However, the sub-analyses focused on “pure laparoscopy” approaches only further failed to show any difference between MILR and OLR. If we consider the cut-off of 50 procedures proposed by Rhu et al for surpassing the learning curve [ 36 ], only a limited number of series was able to overpass it [ 17 , 29 , 30 ]. Approximately 40% of the reported MILR cases have been published only during 2020, and the pure laparoscopic approaches started to be published only in the last 4 years.…”
Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.
“…Lastly, 15 studies were selected for a total of 2094 cases investigated. The MILR cases were 553 (26.4%), and the OLR 1,541 (73.6%) [ 16 – 30 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…However, the sub-analyses focused on “pure laparoscopy” approaches only further failed to show any difference between MILR and OLR. If we consider the cut-off of 50 procedures proposed by Rhu et al for surpassing the learning curve [ 36 ], only a limited number of series was able to overpass it [ 17 , 29 , 30 ]. Approximately 40% of the reported MILR cases have been published only during 2020, and the pure laparoscopic approaches started to be published only in the last 4 years.…”
Adult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.
“…Laparoscopic hepatectomy has several obvious advantages including less pain, smaller scar and earlier return to normal social activity, (4) which may be much more attractive to healthy donors than patients with some diseases to be treated. However, because the donor safety is the most important issue in LDLT and donor hepatectomy is more complex compared to simple hepatectomy, LDH should be performed in highly experienced centers with caution (5)(6)(7).…”
Section: Introduction Introductionmentioning
confidence: 99%
“…Some surgeons proposed a different stepwise approach because there are many centers that are performing few pediatric LDLT. They emphasized that the team could acquire sufficient experience through laparoscopyassisted donor right hepatectomy (LADRH) before initiating pure LDRH (6,7,12,13). In this approach, a move from LADRH to LDRH might be gradually achieved.…”
Section: Introduction Introductionmentioning
confidence: 99%
“…The conversion to laparotomy could be made at any step the surgeon has difficulty to proceed with laparoscopic operation. The proportion of laparoscopic procedures is step by step increased based on the surgeon's incremental experience until at last the whole operation can be safely completed under the laparoscopy (6,12). Because the team can gradually accomplish the learning curve for LDRH through LADRH while ensuring donor safety, this stepwise approach might be easily adopted even in LDLT centers with relatively less experience of laparoscopic hepatectomy.…”
Although laparoscopic donor right hepatectomy (LDRH) is increasingly performed in adult living donor liver transplantation, most experiences have been reported from a limited number of major transplant centers. This is because LDRH requires high-level surgical skills and a guarantee of donor safety. Thus, despite its many advantages, this operation program should be performed with caution, especially in less experienced centers. Various surgical techniques and the know-how have been introduced by several publications in recent years, which include donor's position during operation, selection of port sites and division methods of bile duct and vascular structures. Even though the technical consensus on LDRH has not been established yet, the accumulated experience of major LDRH centers is a good starting point to guide surgeons planning a new LDRH program.
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