Change of Anesthetic Management From Open to Laparoscopic Living Donor Right Hepatectomy After Learning Curve

Abstract

Background: In our hospital, open living donor hepatectomy (OLDH) began in 1996 and laparoscopic living donor hepatectomy (LLDH) began in 2013. In this study, we focus on the change of anesthetic management from OLDH to LLDH.

Methodology: Under the approval of the Institutional Review Board of our hospital, medical records of the last 2 years (2011 and 2012 vs 2019 and 2020) of each OLDH and LLDH era were collected. Left hepatectomy in any period and OLDH during the LLDH era were excluded.

Results: There were 175 OLDHs and 213 LLDHs. We performed 836 cases of OLDH before 2011 and 206 cases of LLDH before 2019. Laryngeal mask airway replaced intubation in half of LLDH cases. Erector spinae plane block was performed in a quarter of LLDH cases. Lung-protective ventilation with low tidal volume and positive end-expiratory pressure were applied for LLDH. Additional peripheral venous line was decreased, and there was no central venous catheterization. Anesthesia duration time was reduced and crystalloid infusion per hour was also decreased. There was no intraoperative transfusion and there was no difference in postoperative transfusion incidence. Reoperation rate was not different. Only 1 donor in OLDH transferred to the intensive care unit after the operation because of uncontrolled hypertension. Length of hospital stay was decreased.

Conclusions: As the surgical tactics for living liver donors become less invasive, the anesthetic strategy also becomes less invasive. In addition, new types of airway management, ventilation method, and analgesic technique have been introduced.