Pure Laparoscopic Left Lateral and Full Left Hepatectomy Including the Middle Hepatic Vein in Living Donors

Abstract

Minimally invasive liver surgery has been widely used for the treatment of different liver diseases. In comparison with standard liver surgery, the laparoscopic approach has the advantage of reducing surgical morbidity, postoperative pain, and recovery time [1–3]. Further developments in laparoscopic surgery have demonstrated its technical feasibility in living donor hepatectomy [4–6]. The first laparoscopic living donor liver transplantation (LDLT) procedure was described in 2002, and since then, this procedure has taken some time to be accepted, most likely because of inherent technical difficulties and the highly demanding surgical skills required to performing it [4]. Later on, specialized units have performed minimally invasive living donor hepatectomy with either the pure (full laparoscopic) technique or the hybrid technique (including hand-assisted procedures and single-port incision [5–9]. Different types of graft procurement, including left lateral sectionectomy and left and right hepatectomy, have been performed [10–13]. Comparative analyses of conventional surgery and minimally invasive techniques for living donor hepatectomy have previously been described [14–16]. However, because of the limited number of reports comparing both techniques and especially because of the low number of patients, it is still not yet clear which method is more beneficial to the donor. According to the 2nd International Consensus Conference on Laparoscopic Liver Surgery, such procedures are classified as Balliol 2b, meaning the need for institutional oversight and a registry to determine short- and long-term outcomes in both donor and recipient (balance of harms) [17].