Article Abstract

Minimally invasive right hepatectomy for living liver donation: a systematic review of the literature

Authors: Francesco Giovanardi, Quirino Lai, Fabio Melandro, Zoe Larghi Laureiro, Anna Di Tomaso, Fabio P. Curci, Redan Hassan, Massimo Rossi, Gianluca Mennini

Abstract

Living donor liver transplantation (LDLT) has emerged as one of the possible solutions for improving the donor pool. However, mainly in case of adult-to-adult donation, performing a right hepatectomy (RH) in a healthy individual should represent a challenge. A way for reducing this shortcoming is the use of mini-invasive surgery. The aim of the present study was, then, to perform a systematic review of the literature investigating the results of the laparoscopic right lobe donation, mainly looking at the different surgical methodologies adopted and the donor complication rates. A systematic search was done following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines: 176 articles were initially screened: eventually, 32 articles were identified, with a total of 501 investigated cases. Pure laparoscopic and robotic right hepatectomies were done in 84 (16.8%) and 14 (2.8%) donors, respectively. Hybrid or assisted procedures were done in 199 (39.7%) and 204 (40.7%) cases, respectively. In the 464 cases in which the postoperative course was exhaustively described for each patient, a total of 85 (18.3%) subjects experienced at least one complication. Twenty-six (5.6%) individuals had a grade III according to the Clavien-Dindo classification: no cases of organ dysfunction nor death were experienced. After stratification of the entire population according to the type of laparoscopic approach adopted (pure-robotic vs. hybrid-assisted), it was interesting to observe that hybrid-assisted cases presented an increased risk of experiencing any complication after RH, with an odds ratio (OR) of 2.53 (P value=0.01). Laparoscopic RH for living donation is a safe procedure. After 501 reported procedures, no deaths have been described. Pure laparoscopic approaches look to consent a lower risk of donor complication respect to hybrid ones. More studies comparing the different laparoscopic approaches with the open procedure are required.