Kwang-Woong Lee1, Suk Kyun Hong1, Kyung-Suk Suh1, Hyo-Sin Kim2, Sung-Woo Ahn3, Kyung Chul Yoon1, Jeong-Moo Lee1, Jae-Hyung Cho1, Hyeyoung Kim4, Nam-Joon Yi1. 1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea. 3. Department of Surgery, Chonbuk National University College of Medicine, Jeonju, Korea. 4. Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
Abstract
BACKGROUND: The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation. METHODS: Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods. RESULTS: During the initial period, 3 (2.6%) donors experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 minutes vs 344.4 minutes; P < 0.001) and hospital stay (7.3 days vs 8.3 days; P = 0.002) were significantly shorter during the more recent period. Also, Δhemoglobin (Hb)%, calculated as ΔHb% = [(preoperative Hb - postoperative Hb)/preoperative Hb] × 100 (14.9% vs 17.5%; P = 0.042), and Δaspartate aminotransferase (AST)%, calculated as ΔAST% = [(peak AST - preoperative AST)/preoperative AST] × 100 (1048.9% vs 1316.6%; P = 0.009), were significantly lower during the recent period. CONCLUSIONS: Pure laparoscopic donor right hepatectomy is both feasible and safe when performed at a center experienced in adult living donor liver transplantation. Performance of about 60 PLDRHs over 1 year is sufficient to standardize the procedure.
BACKGROUND: The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation. METHODS: Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods. RESULTS: During the initial period, 3 (2.6%) donors experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 minutes vs 344.4 minutes; P < 0.001) and hospital stay (7.3 days vs 8.3 days; P = 0.002) were significantly shorter during the more recent period. Also, Δhemoglobin (Hb)%, calculated as ΔHb% = [(preoperative Hb - postoperative Hb)/preoperative Hb] × 100 (14.9% vs 17.5%; P = 0.042), and Δaspartate aminotransferase (AST)%, calculated as ΔAST% = [(peak AST - preoperative AST)/preoperative AST] × 100 (1048.9% vs 1316.6%; P = 0.009), were significantly lower during the recent period. CONCLUSIONS: Pure laparoscopic donor right hepatectomy is both feasible and safe when performed at a center experienced in adult living donor liver transplantation. Performance of about 60 PLDRHs over 1 year is sufficient to standardize the procedure.