Jinsoo Rhu1, Gyu Seong Choi1, Jong Man Kim1, Jae-Won Joh1, Choon Hyuck David Kwon1,2. 1. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Abstract
BACKGROUND: This study analyzed the feasibility of laparoscopic living donor hepatectomy compared to open surgery. METHODS: Donors who underwent living donor right from May 2013 to October 2017 were included. Comparisons between laparoscopy and open surgery were performed using Student's t-test, Mann-Whitney test, χ2 test, Fisher's exact test, and linear-by-linear association. RESULTS: Among 305 donors, 100 and 205 underwent laparoscopy and open surgery, respectively. The laparoscopy group had more type I (95.0%) bile ducts than the open group (59.5%, P < 0.001) and had longer operation time (378.2 ± 93.5 min vs. 329.1 ± 68.0 min, P < 0.001), while estimated blood loss was smaller (298.3 ± 162.9 ml vs. 344.3 ± 149.9 ml, P = 0.015). Although Clavien-Dindo grade IIIb complication was higher in the laparoscopy (n = 4, 4.0%) compared to the open group (0.0%, P = 0.011), it was only significant in the initial 25 cases (8.0%, P = 0.011), and became comparable afterwards. Furthermore, grade IIIb complication was comparable when type I bile duct donors were selected (P = 0.072). CONCLUSIONS: Laparoscopic living donor hepatectomy can cause significant complication in the initial stage. Therefore, careful donor selection and well-established training program are required for introducing the laparoscopic donor program.
BACKGROUND: This study analyzed the feasibility of laparoscopic living donor hepatectomy compared to open surgery. METHODS: Donors who underwent living donor right from May 2013 to October 2017 were included. Comparisons between laparoscopy and open surgery were performed using Student's t-test, Mann-Whitney test, χ2 test, Fisher's exact test, and linear-by-linear association. RESULTS: Among 305 donors, 100 and 205 underwent laparoscopy and open surgery, respectively. The laparoscopy group had more type I (95.0%) bile ducts than the open group (59.5%, P < 0.001) and had longer operation time (378.2 ± 93.5 min vs. 329.1 ± 68.0 min, P < 0.001), while estimated blood loss was smaller (298.3 ± 162.9 ml vs. 344.3 ± 149.9 ml, P = 0.015). Although Clavien-Dindo grade IIIb complication was higher in the laparoscopy (n = 4, 4.0%) compared to the open group (0.0%, P = 0.011), it was only significant in the initial 25 cases (8.0%, P = 0.011), and became comparable afterwards. Furthermore, grade IIIb complication was comparable when type I bile duct donors were selected (P = 0.072). CONCLUSIONS: Laparoscopic living donor hepatectomy can cause significant complication in the initial stage. Therefore, careful donor selection and well-established training program are required for introducing the laparoscopic donor program.
Authors: Yu Jeong Bang; Joo Hyun Jun; Mi Sook Gwak; Justin Sangwook Ko; Jong Man Kim; Gyu Seong Choi; Jae Won Joh; Gaab Soo Kim Journal: Ann Surg Treat Res Date: 2021-03-30 Impact factor: 1.859