Feasibility of total laparoscopic living donor right hepatectomy compared with open surgery: comprehensive review of 100 laparoscopic cases

Background: We designed this study to analyze the feasibility of laparoscopic living donor hepatectomy compared to open surgery. Methods: Donors who underwent living donor right or extended right hemihepatectomy by laparoscopy or open surgery from May 2013 to October 2017 were included. Comparisons between laparoscopy and open surgery were performed. Results: During the study period, 305 patients underwent living donor right or extended right hemihepatectomy. Of these, 100 underwent laparoscopy and 205 underwent open surgery. The laparoscopy group (30.9±11.2 years) were significantly younger than the open group (34.5±12.3 years, P=0.014). The laparoscopy group mostly had type 1 (95.0%) bile duct and 81% had single duct in graft livers, compared with 59.5% type 1 bile duct and 59.5% single bile duct in the open group. The laparoscopy group had significantly longer operation time (378.2 ± 93.5 minutes vs. 329.1 ± 68.0 minutes, P< 0.001) and warm ischemic time (median 271 minutes vs. 151 minutes, P< 0.001). However, estimated blood loss was smaller in the laparoscopy group (298.3 ± 162.9 mL vs. 344.3 ± 149.9 mL, P=0.015). There was no difference in complication rate (laparoscopy group 22.0% vs. open group 15.6%, P=0.170) and the severity of complications classified by Clavien-Dindo system did not differ significantly between the groups (P=0.094). Conclusions: When living donors are selected cautiously, laparoscopic living donor hepatectomy can be performed safely with similar outcome to open surgery. However, the procedure should be performed by a surgeon experienced in both liver transplantation and minimally invasive surgery.