Totally Laparoscopic Right Hepatectomy for Living Donors

Abstract

Laparoscopic right hepatectomy for living donors is a very challenging procedure requiring the cutting-edge techniques of laparoscopic liver surgery. Laparoscopic approach is known to decrease pain, reduce hospital stay, offer early recovery to normal life, and is more cosmetically acceptable and has been applied more frequent for liver donors in recent years. Because of safety issue and the difficulty of the operation, laparoscopic right hepatectomy for living donors should only be done by experienced surgeon in both living donor and laparoscopic liver resection. Some key features for a safe operation are (1) only patients with normal anatomy should be selected; (2) always perform intraoperative cholangiogram and suture the remnant bile duct; (3) in case of bleeding event from venous injury, do not hesitate to apply intermittent inflow occlusion and increase intra-abdominal pressure to balance the central venous pressure which decreases bleeding; and (4) have the right liver placed inside the plastic bag before ligating the vessels to decrease warm ischemic time. Other detailed step-by-step procedures are described.