title: Fully laparoscopic left-sided donor hepatectomy is safe and associated with shorter hospital stay and earlier return to work: A comparative study.
abstract: Living donor liver transplantation has failed to become a major means of transplantation in the United States, where <5% of the transplants are performed with living donors. At least 30% to 50% of the complications of donor hepatectomy appear to be related to abdominal wall trauma, including hernia, bowel obstruction, and chronic abdominal discomfort. We analyzed our experience with laparoscopically procured donor hepatectomy. We compared 22 full laparoscopic donor hepatectomies to 20 open/hybrid hepatectomies over an 11-year period. Donor and recipient demographics, complications, and graft and recipient outcomes were analyzed. All 22 laparoscopically procured liver allografts were transplanted successfully. The laparoscopically procured grafts took longer to procure (7 hours 58 minutes versus 6 hours 38 minutes; P < 0.001). The laparoscopically procured cases had lower blood loss (177.3 versus 3753 cc; P < 0.001), a shorter length of stay, and significantly reduced days off work (P = .01). The 1-year graft survival was not different (90% in the laparoscopic group and 85% in the open group; P = 0.70). The 1-year patient survival was not different (95% in the laparoscopic group and 85% in the open group; P = 0.32). There was a trend toward lower wound issues in the laparoscopic group, but this did not reach significance (the hybrid/open group had a 15% hernia rate versus 5% for the laparoscopic group). In experienced living donor centers, laparoscopic liver donation appears to be feasible for all pediatric recipients and some adult recipients. Outcomes for the recipients of laparoscopically procured grafts do not appear significantly different from outcomes with hybrid/open techniques.
authors: Department of Surgery.
authors: Benjamin
authors: B
authors: Samstein
authors: Department of Surgery.
authors: Adam
authors: A
authors: Griesemer
authors: Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France.
authors: Daniel
authors: D
authors: Cherqui
authors: Department of Surgery.
authors: Tarek
authors: T
authors: Mansour
authors: Department of Surgery.
authors: Joseph
authors: J
authors: Pisa
authors: Department of Surgery.
authors: Anna
authors: A
authors: Yegiants
authors: Center for Liver Disease and Transplantation, Columbia University, New York, NY.
authors: Alyson N
authors: AN
authors: Fox
authors: Department of Surgery.
authors: James V
authors: JV
authors: Guarrera
authors: Department of Surgery.
authors: Tomoaki
authors: T
authors: Kato
authors: Emory Transplant Center, Emory University, Atlanta, GA.
authors: Karim J
authors: KJ
authors: Halazun
authors: Department of Surgery.
authors: Jean
authors: J
authors: Emond
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D062707:Return to Work / Q000706:statistics & numerical data; D055815:Young Adult