title: Totally Laparoscopic Right Hepatectomy for Living Donor Liver Transplantation: Analysis of a Preliminary Experience on 5 Consecutive Cases.
abstract: BACKGROUND
  The pure laparoscopic approach in right hepatectomy (LRH) for living donor liver transplantation (LDLT) is a controversial issue. Some authors have reported the procedure to be feasible but surgical outcomes and impact on short and long-term morbidity rates are yet to be determined. The aim of this study is to present the results of a preliminary 5 consecutive cases series of LRH for LDLT and to compare it with a successive cohort of open right hepatectomies (ORH) for LDLT.
  
  
  METHODS
  From May 2013 to October 2015, 5 consecutive donors underwent LRH for LDLT in our center. The previous last 10 ORH for LDLT were selected for comparison. Special care was taken to include all adverse events. Each patient's complications were graded with the Clavien-Dindo Classification and scored with the Comprehensive Complication Index.
  
  
  RESULTS
  All 5 consecutive donors completed a pure laparoscopic procedure. All allografts (open and laparoscopically procured) were successfully transplanted with no primary graft failures. Only 2 Clavien-Dindo Grade-I complications occurred in the LRH donors, while ORH donors had 10 Grade I, 2 Grade II and 1 Grade IIIa complications in the short term (<3 months). In the long term (6-12 months follow-up), LRH donors had a significant lower incidence of complications (Comprehensive Complication Index: 1.74; SD, 3891 vs 15.2 SD; 8.618; P = 0.006).
  
  
  CONCLUSIONS
  In our experience, LRH for LDLT is a feasible procedure. Further comparative series may support our preliminary findings of reduced incidence and severity of complications as compared with the open approach.
authors.affiliation: 1 Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University Clinic, University of Navarra, Pamplona, Spain. 2 Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain. 3 Abdominal Radiology, Department of Radiology, University Clinic, University of Navarra, Pamplona, Spain. 4 Anesthesiology, University Clinic, University of Navarra, Pamplona, Spain. 5 Hepatology, Department of Internal Medicine, University Clinic, University of Navarra, Pamplona, Spain. 6 Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo
authors.forename: Alberto
authors.initials: A
authors.lastname: Benito
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zozaya
authors.forename: Pablo
authors.initials: P
authors.lastname: Martí-Cruchaga
authors.forename: Francisco
authors.initials: F
authors.lastname: Hidalgo
authors.forename: Luis
authors.initials: L
authors.lastname: Lopez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herrero
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult