Feasibility of Pure Laparoscopic Donor Right Hepatectomy Compared to Open Donor Right Hepatectomy: A Large Single-Center Cohort Study.

Abstract

OBJECTIVE This study aimed to compare morbidity of living donors and recipients after pure laparoscopic donor right hepatectomy (PLDRH) and open donor right hepatectomy (ODRH). BACKGROUND Donor and recipient morbidity have not been sufficiently reported in large-scale comparisons of PLDRH and ODRH. METHODS This retrospective study reviewed 3348 donors who underwent PLDRH (n=329) and ODRH (n=3019) and their corresponding recipients (n=3348) between January 2014 and August 2023. Donor complications and recipient biliary complications within 90 days were evaluated before and after 1:3 propensity score mathcing (PSM). Multivariate logistic regression analyses identified significant risk factors for donor major and biliary complications, as well as recipient bile leakage and biliary stricture. RESULTS For donors, PLDRH had fewer overall complications than ODRH (0.9% vs. 3.7%, P=0.009), with no significant differences in major (Clavien-Dindo III/IV) complications (P=0.057) and biliary complications (P=0.067), despite the absence of biliary complications in PLDRH. However, PLDRH showed longer warm ischemic time and operation time, and higher peak aspartate aminotransferase and alanine aminotransferase levels compared to ODRH in donors (P<0.001). These results remained consistent after PSM. Recipient biliary complications were comparable between PLDRH and ODRH, both before (P=0.806) and after PSM (P=0.149). Multiple portal veins were significant donor risk foctor for major (P=0.022), and biliary complications (P=0.001). Separated multiple bile ducts were common significant recipient risk factor for bile leakage (P=0.007) and biliary stricture (P=0.022). CONCLUSIONS PLDRH could become the standard for donor right hepatectomy with careful consideration of portal and biliary variations for donor and recipient safety.