American Surgical Association

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Pure Laparoscopic Donor Hepatectomy: Ready for Widespread Adoption
Benjamin Samstein*1, Adam Greisemer*2, Karim Halazun*1, Fabrizio Michelassi1, Tomoaki Kato2, Craig Smith2, James V. Guarrera*2, Jean C. Emond2
1Weill Cornell Medicine, New York, NY;2Columbia University Medical Center, New York, NY

OBJECTIVE: Adoption of minimal access techniques to living donor liver transplantation has been slowed by concerns about donor safety and the quality of allografts. We present the largest US series of pure laparoscopic donor hepatectomies (LH).
METHODS: Analysis of a prospectively maintained database of LDLTs performed between 1998-2017 at our institution.
RESULTS: Of 344 donor hepatectomies (DH) for LDLT since 1998, 50 pure laparoscopic donor hepatectomies (LH) have been performed since 2009. There were 31 LLS and 19 full lobectomies LH. We matched full lobe LH to open DH prior to introduction of LH. LH increased from 21% of all donor hepatectomies in first 5 years of performing LH to 45% of DH in the most recent 3 years. Laparoscopic donors were more likely female, had lower BMI, had smaller livers, smaller allografts but longer OR times. In the total LD experience, 4 donors were converted to open surgery (8%), 1 donor required transfusion (2%); there was one donor bile leak (2%). Recipient patient and graft 1-year survival was 98% and 94%.
CONCLUSIONS: Our experience indicates that laparoscopic donor hepatectomy for LDLT can be safely utilized with appropriate attention to learning curve and progression from LLS to right hepatectomy.

Full lobe grafts matched to Open DH
DonorPure LaparoscopicOpenP value
Age (years)39.837.60.489
BMI24.3 +/- 2.627.3 +/- 4.20.01
Weight (kg)67.3 +/- 10.577.8 +/- 16.30.023
Operative Time (minutes)429 +/- 60389 +/- 460.032
Right lobe63%63%
Whole liver Volume (cc)1326 +/- 1791606 +/- 3430.004
Allograft Weight (grams)606 +/- 153736 +/- 2690.077

Outcomes of 50 LH and 50 matched open DH
Donor OutcomesPure LaparoscopicOpen
LOS (days)4.6 +/- 1.55.8 +/- 1.5
Bile leak2%6%
Abdominal wall complications2% hematoma2% port site hernia2% wound infection2 % umbilical hernia 10% incisional hernia

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