Total laparoscopic living donor right hepatectomy

Abstract

Background Right lobe living donor liver transplantation (LDLT) is the predominant form of adult-to-adult LDLT. Accordingly, cosmetic and functional demand by young donors is increasing. We developed the world first total laparoscopic donor right hepatectomy (LDRH) in adult living donors. Methods Total LDRH was performed in two young donors without vascular clamping. Modified extended right graft (right liver including all the middle hepatic vein branches) was retrieved from suprapubic transverse incision. Findings After full mobilization of right liver, hilar dissection was done. First, right portal vein was isolated under retracting common bile duct laterally. Right hepatic artery was cautiously dissected and isolated without injuring. An exact transection line was drawn during transient clamping of the hepatic artery and portal vein on the right side of the liver using bulldog clamp. Dissection was meticulously performed along the right side of the middle hepatic vein until the origin of middle hepatic vein until exposure of the hilar plate. Anterior section vein branches (V5 and V8) were finely dissected and were reconstructed using an artificial vascular graft. A modified extended right graft with preservation of the middle hepatic vein branches was extracted through the suprapubic incision. There was no complication in both donors and recipients. Postoperative hospital stay of donors was 10 and 8 days, respectively. After follow-up of more than 1 year, all donors and recipients live well with normal liver function. Conclusion Total LDRH was feasible in selected adult donors. If this procedure will be more standardized, then total LDRH will be new option for adult LDLT, which meets demand by donors and diminish guilty feeling by recipients [1][2][3][4][5].

Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins

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AbstractBackground Despite increases in the performance of pure laparoscopic living donor hepatectomy, variations in the bile duct or portal vein have been regarded as relative contraindications to this technique [1][2][3]. This report describes a donor with separate right posterior and right anterior hepatic ducts and portal veins who underwent pure laparoscopic living donor right hemihepatectomy, integrated with 3D laparoscopy and indocyanine green (ICG) near-infrared fluorescence cholangiography [1,4,5].

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

“…For this reason, the first minimally invasive approach to donor right hepatectomy was a mini-incision procedure, in contrast to laparoscopic left lateral sectionectomy. However, since the first experience with pure laparoscopic donor right hepatectomy in our hospital in early 2010 [17][18][19], several experienced centers have reported successful pure laparoscopic living donor right hepatectomy [20][21][22][23][24]. Tables 1 and 2 show that the associated blood loss and operation times are similar to those for open donor right hepatectomy, and only 2 major complications were reported in all the series.…”

Use of robotics in liver donor right hepatectomy

“…As illustrated in (20)(21)(22). The reports of these pioneer surgeries confirmed the feasibility of highly selected cases in the hands of experienced MIS surgeons.…”

“…Although left-sided laparoscopic donor hepatectomy is becoming accepted as a potential beneficial alternative to open left sided donor procurement (15), the efforts to extend the procedure for the right-sided liver donation are much more challenging (16). 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).…”