The surgical technique employed during living donor hepatectomy (LDH) has evolved since the inception of the procedure, but donor safety is always paramount. We review our recent experience with open versus laparoscopically assisted living donor hepatectomy over a decade.

Methods: We performed a retrospective review of 185 consecutive LDH between January 2004 and April 2014. 135 donors had an open hepatectomy via a right subcostal incision with midline extension (OH) and 50 underwent a laparoscopically assisted (LAH) hepatectomy. LAH was performed by mobilization of the right lobe of liver from the coronary and triangular ligaments using laparoscopic techniques. The remainder of the LAH was done through a mid-line incision measuring between 10-15 cm. Demographic and clinical parameters and SF-36 domains related to pain were assessed using SPSS statistical software; p<0.05 was significant.

Results: There were 102 males and 83 females with similar percentages in each group. No differences in age, BMI, readmission or incisional hernia rates were found. Postoperative liver function tests peaked on day 1 or 2 for both groups, but were lower each day in the LAH group: AST </del>+ ALT= p< 0.05 on Day2-5; TBili = p< 0.05 on Day 1-7; Creat = p< 0.05 on Day1,2,6,7; INR = p< 0.05 on Day 3,4. At 1 week post-donation, LAH donors indicated less bodily pain (p =0.043) and less interference from pain with physical functioning (p=0.03) than OH donors.

Conclusions: LAH is a safe and effective technique that results in shorter hospital stays, less operative time and reduced resource utilization. LAH donors receive less exposure to anesthesia which increases their safety profile. They experience fewer wound infections and report less pain than OH donors. The also appear to have less disruption of liver function as measured by lab tests. A randomized, multicenter head to head trial is needed to confirm these results.

CITATION INFORMATION: Akoad M, Simpson M, Pomfret E. Laparoscopically Assisted Living Donor Hepatectomy Is Safe and Cost Effective. Am J Transplant. 2016;16 (suppl 3).

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