*Purpose: Few centers in the world are doing PLDRH because of the long learning curve and donor safety concerns. Further longer operative time, difficulty in reproducibility and higher costs make it less attractive as a routine procedure. AimTo design a standardized technique with steps similar to our open donor right Hepatectomy (ODRH), that can be reproduced easily and anticipate donor safety concerns to prevent them. To make it less expensive without bargaining the donor safety.

*Methods: Retrospective analysis of Liver donors who underwent ODRH between Jun2019 to Feb2020 (n=50) and PLDRH between March 2020 to December 2021(n=50) was done. Various clinical and laboratory parameters -operative blood requirement, Surgery time, specimen retrieval time (in PLDH groups), drain bilirubin, HB and LFT at POD 1, POD 5(at discharge) and POD 14(OPD follow up), pain scores, hospital stay, first stool, peak lactate, POD drain removal, complications, re-hospitalization were studied. PLDRH was further studied by subgroup analysis by dividing into early group (n=25) and late group (n=25). Total length of the operative time, length of hospitalization and cost of consumables were compared for the cost effective analysis.

*Results: All patients selected had no comorbidities. There was a statistically significant difference in median operative time ODRH 250 (180-360 min) vs PLDRH 380 (260-520) min (p<0.001). No significant difference was seen in drain bilirubin, HB, and LFT at POD 1, POD 5(at discharge) and POD 14 (follow up in OPD), hospital stay, first stool, peak lactate, POD drain removal, complications, re-hospitalization. Pain scores and patient satisfaction was better in PLDRH group. Fewer bile duct complications but multiple bile duct openings were seen in PLDRH than ODRH. Subgroup analysis showed significantly lesser blood loss 345 (200-600) ml vs. 200 (100-350) (p<0.001) and lesser OR times 410 (300-650) min vs 320 (280-400) min (p<0.001) of early vs. late group. Single blood transfusion was required in one patient who had been converted to open due to bleeding in the early PLDRH group. Length of hospital stay (5 vs 4 days), overall complications and re hospitalizations (1 vs 0) were similar. Graft retrieval time improved with experience (10 vs 6 min). ODRH and late PLDRH were comparable in all the above parameters. It was also observed that once the steps were more standardized, a Junior Surgeon could start adopting the same steps after a learning curve of initial 25 cases

*Conclusions: This study concludes PLDRH is reproducible, safe, cost effective and can be made standardized procedure like the open technique after learning curve of initial 25 cases. Better cosmetic acceptability and more comfortable postoperative course makes PLDRH a more acceptable procedure. Finally, the difference of cost was approximately 500 USD between PLDRH and Open donor right hepatectomy(ODRH).

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