Impact of abdominal shape on living liver donor outcomes in mini-incision right hepatic lobectomy: Comparison among 3 techniques

Liver Transpl. 2018 Apr;24(4):516-527. doi: 10.1002/lt.25001.

Abstract

Although minimally invasive techniques for living donor hepatectomy have been developed, the surgical feasibility and limitations remain to be elucidated. The risks and outcomes involved need to be better understood prior to their widespread application. The aim of this study was to assess feasibility of minimally invasive donor hepatectomy by reviewing our experience. A total of 99 living donor liver transplantations performed between 2000 and 2016 were retrospectively reviewed. All 99 living liver donors underwent right hepatectomy. The breakdown of the techniques is as follows: the standard technique in 33 patients; the laparoscopic-assisted minilaparotomy technique (hybrid technique group) in 19 patients; and the upper midline incision technique without laparoscopic assistance (minilaparotomy group) in 47 patients. An association between donor operative outcomes and body habitus, such as body mass index (BMI), abdominal truncal depth (approximated by celiac axis [CA] depth ratio), and umbilical circumference (UC) were assessed. Perioperative factors were compared between the standard technique and the minimally invasive technique. The minilaparotomy group had significantly shorter operative time (P = 0.046) and hospital stay (P = 0.005) than the standard technique group. Postoperative complication rates were similar between the 3 groups (P = 0.16). In the minilaparotomy group, greater BMI (P = 0.02), CA depth ratio (P = 0.04), and UC (P = 0.004) were found to be risk factors for postoperative complications. In the minilaparotomy group, CA depth ratio > 0.41, UC > 90 cm, and BMI > 30 kg/m2 were significantly associated with longer operative time and hospital stay. In the standard technique group, none of the body size factors were associated with postoperative outcomes. In conclusion, the minilaparotomy technique is safe and feasible, though technical difficulties may be encountered when performed on donors with larger body habitus. Ongoing efforts are required to ensure living donor safety. Liver Transplantation 24 516-527 2018 AASLD.

Publication types

  • Comparative Study

MeSH terms

  • Abdominal Wall / surgery
  • Adult
  • Body Mass Index
  • Feasibility Studies
  • Female
  • Hepatectomy / adverse effects
  • Hepatectomy / methods*
  • Hepatectomy / statistics & numerical data
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Laparoscopy / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Liver / surgery
  • Liver Transplantation*
  • Living Donors / statistics & numerical data*
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Risk Factors
  • Tissue and Organ Harvesting / adverse effects
  • Tissue and Organ Harvesting / methods*
  • Tissue and Organ Harvesting / statistics & numerical data
  • Waist Circumference
  • Young Adult