Safely Implementing a Program of Pure Laparoscopic Donor Right Hepatectomy: The Experience From a Southeast Asian Center

Jia-Hao Law; Chun Han Nigel Tan; Kah Hwee Jarrod Tan; Yujia Gao; Ning Qi Pang; Glenn Kunnath Bonney; Shridhar Ganpathi Iyer; Olivier Soubrane; Wei Chieh Alfred Kow

doi:10.1097/TXD.0000000000001486

Safely Implementing a Program of Pure Laparoscopic Donor Right Hepatectomy: The Experience From a Southeast Asian Center

Transplant Direct. 2023 May 24;9(6):e1486. doi: 10.1097/TXD.0000000000001486. eCollection 2023 Jun.

Authors

Jia-Hao Law^{1

2}, Chun Han Nigel Tan^{1

2}, Kah Hwee Jarrod Tan^{1

2}, Yujia Gao^{1

2}, Ning Qi Pang^{1

2}, Glenn Kunnath Bonney^{1

2}, Shridhar Ganpathi Iyer^{1

2}, Olivier Soubrane³, Wei Chieh Alfred Kow^{1

2}

Affiliations

¹ Division of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, University Surgical Cluster, National University Hospital, Singapore.
² National University Center for Organ Transplantation, National University Hospital, Singapore.
³ Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris and University of Paris, Paris, France.

Abstract

Laparoscopic donor right hepatectomy (LDRH) is a technically challenging procedure. There is increasing evidence demonstrating the safety of LDRH in high-volume expert centers. We report our center's experience in implementing an LDRH program in a small- to medium-sized transplantation program.

Methods: Our center systematically introduced a laparoscopic hepatectomy program in 2006. We started with minor wedge resections followed by major hepatectomies with increasing complexities. In 2017, we performed our first laparoscopic living donor left lateral sectionectomy. Since 2018, we have performed 8 cases of right lobe living donor hepatectomy (laparoscopy-assisted: 4 and pure laparoscopic: 4).

Results: The median operative time was 418 (298-540) min, whereas the median blood loss was 300 (150-900) mL. Two patients (25%) had surgical drain placed intraoperatively. The median length of stay was 5 (3-8) d, and the median time to return to work was 55 (24-90) d. None of the donors sustained any long-term morbidity or mortality.

Conclusions: Small- to medium-sized transplant programs face unique challenges in adopting LDRH. Progressive introduction of complex laparoscopic surgery, a mature living donor liver transplantation program, appropriate patient selection, and the invitation of an expert to proctor the LDRH are necessary to ensure success.