Minimally invasive donor hepatectomy: evolution from hybrid to pure laparoscopic techniques.

TL;DR: Although minimally invasive donor surgery is the best method to use to ensure the complete rehabilitation of healthy volunteers and to lessen their physical and mental burden, whether or not it is safe still remains in question.

Abstract: To the Editor: L iving donor liver transplantation (LDLT) has become a widely accepted therapeutic modality alternative to liver transplantation from deceased donors. However, inherent donor risks and procedure-related complications represent the greatest barriers to the routine use of LDLT.1 Expansion of LDLT has been restricted by the significant surgical risks associated with a major hepatic resection in a healthy individual, including a donor morbidity rate of 20% to 40%; several donor deaths have been reported in the literature and widely in the worldwide media as well.2,3 However, LDLT is here to stay in Asia, especially in Japan, which has limited availability of cadaveric donors. Although minimally invasive donor surgery is the best method to use to ensure the complete rehabilitation of healthy volunteers and to lessen their physical and mental burden, whether or not it is safe still remains in question. We previously developed a laparoscopy-assisted major hepatectomy, which at the time was a new surgical procedure for performing major hepatectomies through a small incision using a hanging maneuver.4 After acquiring additional procedural skills in laparoscopy-assisted major hepatectomy for hepatic tumors, we applied this technique to donor hepatectomy and have been using laparoscopy-assisted donor hepatectomy (LADH) for the procurement of various graft types since 2007. From July 2007 to October 2012, 39 consecutive live donors underwent LADH, including 1 left lateral graft, 8 left lobe grafts, 5 left lobe grafts with the caudate lobe, 22 right lobe grafts, and 3 right lobe grafts with the middle hepatic vein. In 2009, we began using a pure laparoscopic major hepatectomy technique for benign diseases and malignant tumors. After performing a fairly large number of these advanced surgical techniques in both laparoscopy-assisted and pure laparoscopic major hepatectomies, we began performing