Single-Port Laparoscopy-Assisted Donor Right Hepatectomy in Living Donor Liver Transplantation: Sensible Approach or Unnecessary Hindrance?

doi:10.1016/j.transproceed.2012.01.018

Transplantation Proceedings

Volume 44, Issue 2, March 2012, Pages 347-352

https://doi.org/10.1016/j.transproceed.2012.01.018 Get rights and content

Abstract

Background

Single-port laparoscopic (SPL) surgery has rapidly gained attention worldwide. Since May 2008, we have propagated the use of SPL surgery, mainly for cholecystectomy and appendectomy. Recently, we have used this modality of minimally invasive surgery for various liver surgeries. We hereby discuss our outcomes of SPL-assisted donor right hepatectomies.

Methods

The preoperative workup is the same as for a standard donor hepatectomy. We retrospectively reviewed the data of 150 patients who underwent donor right hepatectomy from October 2008 to May 2011. We divided them into 3 groups depending on the type of surgical procedure.

Results

Among 150 patients, 20 underwent laparoscopy-assisted donor right hepatectomy (LADRH); 40 underwent single-port laparoscopy-assisted donor right hepatectomy (SPLADRH); and 90 underwent open donor right hepatectomy (ODRH). The donor demographics were comparable among the groups. Postoperative complication and reoperation rates revealed no significant differences. The SPLADRH group showed the lowest level of postoperative pain, thereby leading to a better quality of life postoperatively.

Conclusions

SPLADRH seems to be a simple, feasible approach.

Section snippets

Methods

Our Institutional Review Board approved our study. From October 2008 to May 2011, 150 patients underwent donor right hepatectomy. In December 2008, we performed our first LADRH; since October 2009, we used SPLADRH and since February 2010 only SPLADRH. Therefore, to May 2011, 20 patients underwent LADRH, 40 underwent SPLADRH, and 90 underwent ODRH. We retrospectively reviewed the data according to each group. Demographic features, laboratory values, as well as operative and postoperative data

Results

The 3 groups differed in size (SPLADRH n = 40; LADRH n = 20; and ODRH n = 90). However, donor demographics for all 3 groups, including age (P = .11), gender (P = .739), and body mass index (BMI; P = .744), showed no significant difference. The preoperative aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT/INR), and hemoglobin (Hb) levels were similar in each group. The preoperative total bilirubin (TB) levels, incidentally, in the SPLADRH and LADRH groups

Discussion

LDLT is a vital option for patients with decompensated liver cirrhosis and/or HCC in Korea due to a lack of deceased donors. Currently, laparoscopic procedures have become the standard of care, helping to increase living kidney donations.18, 19 Thus laparoscopic living donor hepatectomy may be a definite aid to substantially increase the donor pools.

Yet, total laparoscopic donor hepatectomy is a controversial subject in the field of liver surgery.²⁰ In pediatric liver transplantation, some

References (27)

R.S. Brown
Live donors in liver transplantation
Gastroenterology
(2008)
R.M. Ghobrial et al.
Donor morbidity after living donation for liver transplantation
Gastroenterology
(2008)
A. Marcos
Right lobe living donor liver transplantation: a review
Liver Transpl
(2000)
J.F. Trotter et al.
Right hepatic lobe donation for living donor liver transplantation: impact on donor quality of life
Liver Transpl
(2001)
C. Simillis et al.
Laparoscopic versus open hepatic resections for benign and malignant neoplasms–a meta-analysis
Surgery
(2007)
T.B. Baker et al.
Laparoscopy-assisted and open living donor right hepatectomy: a comparative study of outcomes
Surgery
(2009)
I. Kurosaki et al.
Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation
Surgery
(2006)
A. Thenappan et al.
Liver allograft outcomes after laparoscopic assisted and minimal access live donor hepatectomy for transplantation
Am J Surg
(2011)
A.J. Koffron et al.
Laparoscopic-assisted right lobe donor hepatectomy
Am J Transplant
(2006)
E.R. Podolsky et al.
Single port access (SPA) surgery – a 24-month experience
J Gastrointest Surg
(2010)

J.R. Leventhal et al.

Laparoscopic donor nephrectomy 1997 to 2003: lessons learned with 500 cases at a single institution

Surgery

(2004)

D. Cherqui et al.

Laparoscopic living donor hepatectomy for liver transplantation in children

Lancet

(2002)

A.J. Koffron et al.

Evaluation of 300 minimally invasive liver resections at a single institution: less is more

Ann Surg

(2007)

Cited by (48)

Long-term medical and quality of life outcomes among voluntary liver donors
2024, Journal of Gastrointestinal Surgery
Long-term medical and quality of life (QOL) outcomes in voluntary liver donors remain under investigated. The objective of the current study was to report long-term medical outcomes and re-evaluate QOL in living liver donors.
This was a single-center retrospective cohort study of donors who underwent donor hepatectomy between 2012 and 2018. We investigated long-term outcomes in 7 domains. These include medical problems, surgical procedures, work-related issues, pregnancy outcomes, psychiatric interventions, willingness to donate again, and long-term mortality. QOL was evaluated using short-form 36.
The median follow-up time was 61.4 months (53.3-83.7). Among 698 donors, 80 (11.5%) experienced medical problems, 4 (0.6%) had work-related issues, and 20 (2.9%) needed psychiatric assistance. Surgery was performed in 49 donors (7%), and females were more likely to have undergone incisional hernia repair (5.8% vs 1.9%, P = .006). There were 79 postdonation pregnancies including 41 normal vaginal deliveries (51.9%), 35 cesarean sections (44.3%), and 3 miscarriages (3.8%). Willingness to donate again was reported by 658 donors (94.3%). Donors whose recipients were alive were more likely to donate again (95.5% vs 90.5%, P = .01). There were 3 deaths (0.4%) in the long-term. The mean physical composite score at initial and follow-up evaluation was 86.7 ± 13.9 and 76.5 ± 20.9 (P = .001), and the mean mental composite score at initial and follow-up evaluation was 92.1 ± 13.5 and 80.7 ± 16 (P = .001).
The overall long-term outlook in living liver donors is promising. QOL parameters might deteriorate over time and frequent re-evaluation might be considered.
Pure Laparoscopic Donor Left Hepatectomy Reduces Postoperative Analgesic Use and Pain Scale
2023, Transplantation Proceedings
Many recent reports have described the efficacy and safety of pure laparoscopic donor hepatectomy (PLDH). Here we investigated the extent to which this technique could reduce patients’ experienced pain.
Among donor left hepatectomy procedures performed between July 2011 and November 2022, we retrospectively analyzed 20 open donor hepatectomy (ODH), 20 laparoscopy-assisted donor hepatectomy (LADH), and 5 PLDH cases. We compared these 3 procedures regarding the total amount of postoperative analgesic use (narcotics and non-narcotics) and the first date when the donor was completely pain-free, as evaluated by the patients using a pain scale.
Total postoperative fentanyl use did not significantly differ among the 3 procedures: median (range), ODH, 0.5 mg (0-2 mg); LADH 1.2 mg (0-7 mg); PLDH, 0.5 mg (0-3.5; P = .172). The percentage of patients who completely discontinued analgesics on postoperative day (POD) 5 was significantly higher for PLDH (80%) than for ODH (35%) or LADH (20%) (P = .041). The day when 50% of donors were completely pain-free on a pain scale was POD9 for ODH, POD11 for LADH, and POD5 for PLDH, significantly shorter in the PLDH group (P = .004).
At our institution, we found that PLDH was a useful technique for postoperative pain management compared with PDH and LADH. Our results suggest that PLDH effectively reduces the duration of postoperative analgesia use. Further studies are warranted as the number of PLDH cases gradually increases.
A systematic review and network meta-analysis of outcomes after open, mini-laparotomy, hybrid, totally laparoscopic, and robotic living donor right hepatectomy
2022, Surgery (United States)
Citation Excerpt :
A total of 1,007 records were identified through electronic database searching, of which 32 full-text articles were eligible for quality assessment and quantitative synthesis. A total of 19 studies comprising 2,261 donors were included.6,13,22–38 There were 1,260 (55.7%) patients who underwent Open, 509 (22.5%) patients who underwent Lap, 355 (15.7%) patients who underwent Hybrid, 70 (3.1%) patients who underwent Minilap, and 67 (3.0%) patients who underwent Robotic.
A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open (Open), mini-laparotomy (Minilap), hybrid (Hybrid), totally laparoscopic (Lap), and robotic living donor right hepatectomy (Robotic).
PubMed, EMBASE, Cochrane, and Scopus were searched from inception to August 2021 for comparative studies of patients who underwent living donor right hepatectomy.
Nineteen studies comprising 2,261 patients were included. Operation time was longer in Lap versus Minilap and Open (mean difference 65.09 min, 95% confidence interval 3.40–126.78 and mean difference 34.81 minutes, 95% confidence interval 1.84–67.78), and in Robotic versus Hybrid, Lap, Minilap, and Open (mean difference 144.72 minutes, 95% confidence interval 89.84–199.59, mean difference 113.24 minutes, 95% confidence interval 53.28–173.20, mean difference 178.33 minutes, 95% confidence interval 105.58–251.08 and mean difference 148.05 minutes, 95% confidence interval 97.35–198.74, respectively). Minilap and Open were associated with higher blood loss compared to Lap (mean difference 258.67 mL, 95% confidence interval 107.00–410.33 and mean difference 314.11 mL, 95% confidence interval 143.84–484.37) and Robotic (mean difference 205.60 mL, 95% confidence interval 45.92–365.28 and mean difference 261.04 mL, 95% confidence interval 84.26–437.82). Open was associated with more overall complications compared to Minilap (odds ratio 2.60, 95% confidence interval 1.11–6.08). Recipient biliary complication rate was higher in Minilap and Open versus Hybrid (odds ratio 3.91, 95% confidence interval 1.13–13.55 and odds ratio 11.42, 95% confidence interval 2.27–57.49), and lower in Open versus Minilap (OR 0.07, 95% confidence interval 0.01–0.34).
Minimally invasive donor right hepatectomy via the various techniques is safe and feasible when performed in high-volume centers, with no major differences in donor complication rates and comparable recipient outcomes once surgeons have mounted the learning curve.
Safety and feasibility of laparoscopic living donor right hepatectomy for adult liver transplantation: a meta-analysis
2021, HPB
Laparoscopic living donor right hepatectomy (LDRH) was a controversial topic due to its unknown safety and feasibility.
PubMed, EMBASE and Cochrane Library databases were searched for studies comparing LDRH with open living donor right hepatectomy (ODRH), which were published between the date of database establishment and June 2020. Revman5.3 was used for statistical analysis.
Fourteen studies were included. For the donors, there was no significant difference in warm ischemic time, hospital stay, graft weight, hepatic arterial anomalies (HAA), hepatic vein anomalies (HVA), portal vein anomalies (PVA), biliary anomalies, bleeding, wound infection, severe complication rate and readmission rate. The estimated blood loss, incidence of complication, intra-abdominal fluid rate in the LDRH group were significantly lower than those in the ODRH group, while the operation time, time to remove liver in the LDRH group were significantly higher than those in the ODRH group. For the recipients, there was no significant difference in complication rate, bleeding, HAA, PVA, biliary anomalies, graft failure and mortality. The HVA rate in the LDRH group was significantly higher than that in the ODRH group.
LDRH is safe and feasible for adult living donor liver transplantation compared with ODRH and it can reduce intraoperative bleeding and postoperative complication in donors, which requires further verification by more multi-center comparative studies with large sample and high quality.
Changes in the quality of life of living liver donors: A meta-analysis
2020, International Journal of Nursing Studies
Citation Excerpt :
Besides ensuring strict screening criteria, the selected donor should be observed and supported by supplementary interventions. Optimized surgical techniques for liver resection, such as laparoscopy-assisted living donor surgery, which has fewer incision-related symptoms, may improve the quality of life of living liver donors (Choi et al., 2012; Kitajima et al., 2017). Regular follow-up examinations are thus needed to identify and treat medical conditions induced by liver donation.
Comprehending the physical, psychological, social benefits, and harm associated with liver donation is critical in promoting practices to maintain donors’ long-term health. However, changes in quality of life among living liver donors pre- and post-donation have not been established.
This meta-analysis of prospective longitudinal studies examined the quality of life changes among living liver donors pre- and post-donation.
PubMed, Embase, CINHAL with full text, and ProQuest Dissertations & Theses were mainly searched for full-text articles from inception till December 2018 to identify studies assessing the quality of life of living liver donors. The methodological quality of the included studies was examined. The quality of life post-donation at five assessment points, ≤1 month, 3 months, 6 months, 12 months, and ≥ 24 months were compared with the pre-donation, respectively.
The search yielded 2215 records, and a total of 15 articles (13 studies) with 715 donors were included in this meta-analysis. Physical functioning scores at ≤1 month, 3 months, 6 months, 12 months, and ≥24 months post-donation were significantly lower than pre-donation [overall standardized mean difference (SMD) = -0.67, 95% CI: -0.86, -0.49; p ≤]. Significantly higher level of pain was found at 3-month post-donation (SMD, -1.05; 95% CI: -1.26, -0.85; p < 0.00001). Also, a significantly higher level of anxiety was found at 3-month post-donation (SMD, -0.29; 95%CI: -0.51, -0.07; p = 0.01), but there were no significant changes in general psychological state and depression. A significant reduction in donors’ social quality of life (SMD, -2.61; 95%CI: -4.75, 0.48; p = 0.02) was found at ≤1-month post-donation, and recovery to pre-donation levels occurred at 3 months post-donation.
Living liver donation was associated with a decline in physical functioning, which was sustained for longer than 2 years post-donation. Impaired social and psychological quality of life affected donors for 1–3 months after their donation. The quality of life of living liver donors has become a pressing issue requiring more attention from doctors and nurses within the transplant team. However, multicenter, prospective, and longitudinal studies are needed to confirm the long-term safety of living liver donors.
Laparoscopy-assisted versus open and pure laparoscopic approach for liver resection and living donor hepatectomy: a systematic review and meta-analysis
2018, HPB
Citation Excerpt :
Lin et al.16 performed a systematic review comparing PLLR, HALS and hybrid surgery for major resections and concluded that hybrid approach has its best applicability for resection of lesions in difficult locations, patients scheduled to technical difficulties and resections that require delicate hilar dissection, as living-donor hepatectomy. In fact, the hybrid technique has its optimal applicability in living donation due to the complexity of the procedure.27,28,32 Hybrid surgery is used more often in Eastern centers, especially in Japan.
Laparoscopy-assisted (hybrid) liver surgery is considered a minimally invasive technique, however there are doubts regarding loss of the benefits of laparoscopy due to the use of an auxiliary incision. The aim of this study was to compare perioperative results of hybrid vs. open and hybrid vs. pure laparoscopic approach to liver resection for focal lesions and living donation.
A systematic review was performed in Medline, EMBASE, Cochrane Library Central and LILACS databases. Perioperative outcomes were analyzed.
21 studies were included. Hybrid vs. open: operative time was lower in open group (mean difference [MD] = 34 min; 95%CI: 22–47; P < 0.001; N = 669). Hybrid technique was associated with a reduction in operative blood loss [MD = −43 ml; 95%CI: −74–(−13); P = 0.005, N = 1738]; shorter hospital stay [MD = −1.9 days; 95%CI: −3.2–(−0.5); P = 0.008; N = 833] and lower morbidity [risk difference (RD) = −0.05; 95%CI: −0.10–(−0.01); P = 0.010; N = 1359]. Hybrid vs. pure laparoscopic: There was no difference regarding blood loss, transfusion rate, hospital stay and morbimortality.
Hybrid technique had perioperative outcomes that were more in keeping with pure laparoscopic outcomes than open surgery. Hybrid liver surgery should be considered a minimally invasive approach.

View all citing articles on Scopus

View full text

Advances in liver transplantationDonation: Technical aspectSingle-Port Laparoscopy-Assisted Donor Right Hepatectomy in Living Donor Liver Transplantation: Sensible Approach or Unnecessary Hindrance?

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Gastroenterology

Gastroenterology

Liver Transpl

Liver Transpl

Surgery

Surgery

Surgery

Am J Surg

Am J Transplant

J Gastrointest Surg

Surgery

Lancet

Evaluation of 300 minimally invasive liver resections at a single institution: less is more

Ann Surg

Advances in liver transplantation
Donation: Technical aspect
Single-Port Laparoscopy-Assisted Donor Right Hepatectomy in Living Donor Liver Transplantation: Sensible Approach or Unnecessary Hindrance?