Aim: We previously reported 28 consecutive cases of minimally invasive living donor right hepatectomy (10cm mini-incision right hepatectomy with or without laparoscopic assistance). Currently, we routinely use the upper midline incision without laparoscopic assistance. The aim of this study was to investigate the surgical feasibility and safety of this approach based on our updated experience.

Methods: Between December 2000 and March 2015, living donor right hepatectomy was performed in 91 patients. The first 33 cases were performed through standard subcostal incision with midline extension (Group 1). Hybrid technique (hand-assisted laparoscopic liver mobilization and mini-laparotomy for hilar and parenchymal dissection) was introduced in 2008 and used in 19 patients until 2011 (Group 2). Upper midline incision (10 cm) right hepatectomy without laparoscopic assistance was introduced in 2010 and was applied to the rest of 39 cases (Group 3). All procedures were performed by the same surgeon. Surgical factors, donor characteristics, and postoperative course in the mini-incision group (Group 3) were investigated in comparison with those in the standard incision group (Group 1). Surgical complications were evaluated according to the Clavien-Dindo classification.

Results: Operative time was significantly shorter in Group 3 than in Group 1 (337min vs. 365min, P=0.02). Estimated blood loss was comparable (338ml vs. 318ml, P=0.53). Length of hospital stay was significantly shorter in the Group 3 (6.2 days vs. 7.9 days, P<0.001). Postoperative complication rate was lower in Group 3 (6/32 [18%] vs. 3/39 [8%], P=0.26). Of these 3 patients in Group 3, one patient was categorized as grade 3b (exploratory laparotomy for postoperative bleeding), and two patients had grade 2 complication (biloma and postoperative transfusion). There was no patient in our entire cohort who had grade 4 (life-threatening) or 5 (death) complication . With regard to donor body habitus in Group 3, the maximum body mass index, and estimated graft weight were 35 and 1549mL, respectively. No conversion was observed from the mini midline incision technique to the standard subcostal incision technique.

Conclusion: Our increased experience with the mini-laparotomy technique validates the safety and feasibility of this approach. This unique procedure could be safely applied in experienced hands to living liver donor without laparoscopic assistance and within a broad weight range.

CITATION INFORMATION: Nagai S, Yoshida A, Rizzari M, Collins K, Kim D, Abouljoud M. Updated Experience of Living Donor Right Hepatectomy Using Mini-Incision Technique. Am J Transplant. 2016;16 (suppl 3).

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