Minimally invasive donor hepatectomy, are we ready for prime time?

doi:10.3748/wjg.v24.i25.2698

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World Journal of Gastroenterology

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World J Gastroenterol. Jul 7, 2018; 24(25): 2698-2709
Published online Jul 7, 2018. doi: 10.3748/wjg.v24.i25.2698

Table 1 Outcomes of hand-assisted and laparoscopic-assisted donor hepatectomy

	LLS	Left	Right	OT (min)	Blood loss (mL)	WIT (min)	HS (d)	Donor Cx	Recipient Cx
Hand-assisted
Suh et al[42], 2009			2	765-898	-	-	10-14	2 (100%)^a	2 (100%)^b
Hybrid
Comparative study
Kurosaki et al[44], 2006^c		10/12	3/1	363 ± 33/320 ± 68	302 ± 191/283 ± 371	3	11.0 ± 2.7/12.8 ± 4.9	-	^d
Baker et al[45], 2009			33/33	265 ± 58¹/316 ± 61	417 ± 217/550 ± 305	-	4.3/3.9	7 (21.2%)^e	-
Thenappan et al[46], 2011^f	8/7			312 ± 68/324 ± 106	1033 ± 1096/733 ± 457	-	6.0 ± 2.0/6.4 ± 3.7	2 (13.3%)^g	7 (46.7%)^h
Choi et al[48], 2012ⁱ			40/20/90	279 ± 72/384 ± 42¹/303 ± 61	450 ± 316/870 ± 653¹/532 ± 323	-	11.8 ± 4.5/12.1 ± 2.8/12.0 ± 3.6	5 (12.5%)^j/6 (30.0%)^k	-
Marubashi et al[49], 2013^l	17/32	14/47		435 ± 103¹/383 ± 73	353 ± 396/456 ± 347		10.3 ± 3.3¹/18.3 ± 16.7	3 (9.7%)^m	-
Nagai et al[55], 2012ⁿ			19/30	371 ± 52/363 ± 53	212 ± 114¹/316 ± 121	-	5.9 ± 1.2¹/7.8 ± 2.3	7 (25.0%)^o	10 (35.7%)^p
Makki et al[50], 2014			26/24	703 ± 124/675 ± 118	337 ± 89/396 ± 126	-	-	4 (15.4%)^q	2 (7.8%)^r
Shen et al[51], 2016^s			28/20	386 ± 49/366 ± 45	384 ± 180/416 ± 164	3.0 ± 1.6/2.9 ± 1.5	7.4 ± 2.5/7.3 ± 1.6	5 (17.9%)^t	-
Kitajima et al[52], 2017		35/38		459 (310-633)¹/403 (256-597)	245 (22-1840)/400 (20-1638)	-	12 (7-50)/12 (8-31)	8 (22.9%)^u	13 (17.1%)^v
Kitajima et al[52], 2017			41/39	431 (310-651)/402 (315-588)	201 (10-1559)¹/313 (55-2165)	-	12 (8-27)/ 12 (7-40)	9 (22.0%)^w
Case series
Koffron et al[43], 2006			1	235	150	-	3	0	0
Suh et al[42], 2009			7	310-575	-	-	8-17	4 (57.1%)^x	5 (71.4%)^y
Soyama et al[47], 2012		9	6	456 (328-581)	520 (230-1000)	-	-	1 (6.7%)^z	-

¹Statistically significant;

^aIntra-abdominal collection and pleural effusion in both patients;

^bBiliary stricture and stroke in one patient and bile leak and biliary stricture in the other patient;

^cCombined results of left and right hepatectomy;

^dThree (23%) early graft loss within 2 mo;

^eSmall bowel injury (n = 1), biloma (n = 1) and other complications (n = 3);

^fCombined results of 15 hybrid and mini-laparotomy compared with 15 open operations, types of graft other than left lateral section not specified;

^gBile leak (n = 1) and incisional hernia (n = 1);

^hBile leak (n = 2), vascular complications (n = 3), intra-abdominal collection (n = 1) and chylous ascites (n = 1);

ⁱSingle-port laparoscopic-assisted (n = 40) vs laparoscopic-assisted (n = 20) vs open (n = 90);

^jIntra-abdominal bleeding (n = 2), bile leak (n = 3) and pleural effusion (n = 1);

^kWound complication (n = 2), diaphragmatic hernia (n = 1), pleural effusion (n = 2) and biliary stricture (n = 1);

^lCombined results of donor left lateral sectionectomy and left hepatectomy;

^mDelayed gastric emptying requiring endoscopy (n = 2) and grade I complication (n = 1);

ⁿCombined results of 19 hybrid and 9 mini-laparotomies compared with 30 open operations;

^oIntra-abdominal bleeding (n = 1), bile leak (n = 1), intra-abdominal collection (n = 1), ileus (n = 2), deep vein thrombosis (n = 1) and phlebitis (n = 1);

^pBile leak (n = 2), biliary stricture (n = 2), hepatic artery stricture (n = 2), hepatic vein stricture (n = 2) and intra-abdominal collection (n = 2);

^qPleural effusion requiring tapping (n = 1) and grade I complications (n = 3);

^rBile leak (n = 1) and biliary stricture (n = 1);

^sLaparoscopic-assisted (n = 28) compared against mini-laparotomy (n = 20);

^tIntra-abdominal bleeding (n = 1), ileus (n = 1), pneumonia (n = 1) and pleural effusion (n = 2);

^uBile leak (n = 3), intra-abdominal collection (n = 1), pneumonia (n = 1) and grade I complications (n = 3);

^vCombined results of left and right hepatectomy; bile leak (n = 5), biliary stricture (n = 5), portal vein thrombosis (n = 2), arterial complication (n = 1);

^wFever of unknown origin (n = 2), renal failure (n = 1), small bowel obstruction (n = 1) and grade I complications (n = 5);

^xBile leak (n = 1), intra-abdominal collection (n = 1) and pleural effusion (n = 3);

^yBile leak (n = 1), portal vein thrombosis (n = 1) and biliary stricture (n = 3);

^zPortal vein thrombosis. Cx: Complications; HS: Hospital stay; LLS: Left lateral section; OT: Operating time; WIT: Warm ischaemic time.

Table 2 Outcomes of donor hepatectomy with mini-laparotomy

	LLS	Left	Right	OT (min)	Blood loss (mL)	WIT (min)	HS (d)	Donor Cx	Recipient Cx
Comparative study
Kim et al[53], 2009			23/23	232 ± 29¹/269 ± 37	186 ± 59/218 ± 67	-	10 ± 3/12 ± 4	3 (13.0%)^a	1 (4.3%)^b
Thenappan et al[46], 2011^c	8/7	-	-	312 ± 68/324 ± 106	1033 ± 1096/733 ± 457	-	6.0 ± 2.0/6.4 ± 3.7	2 (13.3%)^d	7 (46.7%)^e
Nagai et al[55], 2012^f			9/30	371 ± 52/363 ± 53	212 ± 114¹/316 ± 121	-	5.9 ± 1.2¹/7.8 ± 2.3	7 (25.0%)^g	10 (35.7%)^h
Shen et al[51], 2016ⁱ			20/28	366 ± 45/386 ± 50	416 ± 164/383 ± 180	2.9 ± 1.5/3.0 ± 1.6	7.3 ± 1.6/7.4 ± 2.5	1 (5.0%)^j
Case series
Lee et al[54], 2011			141	254 ± 47	352 ± 144	-	10 ± 3	25 (17.7%)^k	51 (36.2%)^l

¹Statistically significant;

^aIntra-abdominal bleeding (n = 2) and pleural effusion (n = 1);

^bBile leak requiring laparotomy (n = 1);

^cCombined results of 15 hybrid and mini-laparotomy compared with 15 open operations, types of graft other than left lateral section not specified;

^dBile leak (n=1) and incisional hernia (n = 1);

^eBile leak (n = 2), vascular complications (n = 3), intra-abdominal collection (n = 1) and chylous ascites (n = 1);

^fCombined results of 19 hybrid and 9 mini-laparotomies compared with 30 open operations;

^gIntra-abdominal bleeding (n = 1), bile leak (n = 1), intra-abdominal collection (n = 1), ileus (n = 2), deep vein thrombosis (n = 1) and phlebitis (n = 1);

^hBile leak (n = 2), biliary stricture (n = 2), hepatic artery stricture (n = 2), hepatic vein stricture (n = 2) and intra-abdominal collection (n = 2);

ⁱMini-laparotomy (n = 20) compared against laparoscopic-assisted (n = 28);

^jPneumonia;

^kRhabdomyolysis (n = 1), intra-abdominal bleeding (n = 4), bile leak (n = 4), ileus (n = 2) and grade I complications (n = 14);

^lBiliary complications (n = 36), intra-abdominal bleeding (n = 5) and vascular complications (n = 6). Cx: Complications; HS: Hospital stay; LLS: Left lateral section; OT: Operating time; WIT: Warm ischaemic time.

Table 3 Outcomes of pure laparoscopic donor left lateral sectionectomy

	No.	OT (min)	Blood loss (mL)	WIT (min)	Conversion	HS (d)	Donor Cx	Recipient Cx
Comparative study
Soubrane et al[28], 2006	16/14	320 ± 67¹/224 ± 15	19 ± 44¹/99 ± 185	10 (6-12)/5(2-7)	1 (6.3%)	7.5 ± 2.3/8.1 ± 3.0	3 (18.7%)^a/5 (35.7%)	6 (37.5%)^b/6 (42.8%)
Kim et al[61], 2011	11/11	330 ± 68/306 ± 29	396 ± 72/464 ± 78	6 ± 2/5 ± 1	0	6.9 ± 0.3¹/9.8 ± 0.9	0/1 (9.1%)	2 (18.1%)^c/2 (18.1%)
Samstein et al[40], 2015^d	17/20	478 ± 68¹/398 ± 42	177 ± 101¹/375 ± 191	-	0	4.3 ± 1.5¹/6.0 ± 1.5	2 (9.1%)^e/5 (25%)	1 (4.5%)^f/1 (4.5%)
Case series
Cherqui et al[12], 2012	2	360-420	150-450	4-10	0	5-7	0	1 (50.0%)^g
Yu et al[92], 2012	15	331 ± 63	410 ± 71	6 ± 2	0	7.1 ± 0.8	0	-
Scatton et al[62], 2015^h	67	275 (175-520)	82 ± 79	9 ± 4	4 (5.7%)	6 (3-18)	17 (25.3%)ⁱ
Soubrane et al[63], 2015^j	124	308 (180-555)	50 (10-500)	8	5 (4.0%)	6.3 (2-18)	21 (16.9%)^k	-
Troisi et al[64], 2017	11	237 ± 99	70 ± 41	4	0%	4	2 (18.1%)^l	5 (45.4%)^m

¹Statistically significant;

^aBile leak requiring laparoscopy (n = 1) and wound haematoma (n = 2);

^bPortal vein thrombosis requiring re-transplant (n = 1), hepatic artery thrombosis (n = 2) and biliary stricture (n = 3);

^cPortal vein stenosis requiring stenting (n = 1) and biliary stricture (n = 1);

^dResults included 5 left hepatectomy and compared with mixed open and hybrid controls;

^eHernia (n = 1) and bile leak (n = 1);

^fPortal vein thrombosis requiring exploration (n = 1);

^gHepatic artery thrombosis (n = 1);

^hResults included 3 left hepatectomy;

ⁱBile leak (n = 2), biliary stricture (n = 1), pulmonary complications (n = 2), bladder injury (n = 1), and complications (n = 5);

^jCombined results of 5 centres;

^kBile leak (n = 3), wound haematoma requiring drainage (n = 1), bladder injury requiring cystoscopy (n = 1), fluid collection requiring drainage (n = 1), others: grade I-II complications;

^lHepatic necrosis (n = 1) and collection (n = 1)

^mFungemia leading to death (n = 1) and biliary stricture (n = 4). Cx: Complications; HS: Hospital stay; LLS: Left lateral section; OT: Operating time; WIT: Warm ischaemic time.

Table 4 Outcomes of pure laparoscopic donor right hepatectomy

	No.	OT (min)	Blood loss (mL)	WIT (min)	Conversion	HS (d)	Donor Cx	Recipient Cx
Comparative study
Takahara et al[67], 2015	5/25	480 ± 54¹/380 ± 45	91 ± 69¹/268 ± 194	9	0	9.4 ± 1.8/9.0 ± 2.2	1 (20%)^a	-
Suh et al[37], 2018	45/42	331 ± 50¹/280 ± 40	436 ± 170¹/338 ± 188	12.6 ± 4.4¹/5.4 ± 3.6	0	8.2 ± 1.3/8.4 ± 1.0	5 (11.9%)^b	11 (26.2%)^c
Case series
Soubrane et al[13], 2013	1	480	100	12	0	7	0	0
Rotellar et al[32], 2013	1	480	100	3	0	4	0	1 (100%)^d
Han et al[33], 2015^e	2	-	-	-	9	9 (8-10)	-	-
Chen et al[39], 2015	1	415	150	6	0	6	1 (100%)^f	1 (100%)^g
Kim et al[36], 2017	3	427-502	200-270	4.5-5.0	0	7-8	0	0

¹Statistically significant;

^aBiliary complication;

^bLiver abscess (n = 1), Pneumonia (n = 1), upper respiratory tract infection (n = 1) and grade I complications (n = 2);

^cIntra-abdominal bleeding (n = 4), vascular complication (n = 4), biliary complication (n = 2) and others;

^dPneumonia;

^eVideo presentation;

^fWound haematoma;

^gPneumonia. Cx: Complications; HS: Hospital stay; OT: Operating time; WIT: Warm ischaemic time.

Table 5 Outcomes of pure laparoscopic donor left hepatectomy

	No.	OT (min)	Blood loss (mL)	WIT (min)	Conversion	HS (d)	Donor Cx	Recipient Cx
Comparative study
Samstein et al[40], 2015^a	5/20	478 ± 68¹/398 ± 42	177 ± 101¹/375 ± 191	-	0	4.3 ± 1.5¹/6.0 ± 1.5	2 (9.1%)^b/5 (25%)	1 (4.5%)^c/1 (4.5%)
Case series
Samstein et al[71], 2013	2	358-379	125	-	0	4 ± 1	0	1 (50%)^d
Troisi et al[72], 2013	4	370-560	50-80	4-7	0	4-6	0	1 (25%)e
Almodhaiberi et al[73], 2018	1	300	125	-	0	8	0	-

¹Statistically significant;

^aResults included 17 left lateral sectionectomies and compared with mixed open and hybrid controls;

^bHernia (n = 1) and bile leak (n = 1);

^cPortal vein thrombosis requiring exploration (n = 1);

^dBile leak (n = 1); ^eRecipient common hepatic artery dissection (n = 1). Cx: Complications; HS: Hospital stay; OT: Operating time; WIT: Warm ischaemic time.

Citation: Au KP, Chok KSH. Minimally invasive donor hepatectomy, are we ready for prime time? World J Gastroenterol 2018; 24(25): 2698-2709
URL: https://www.wjgnet.com/1007-9327/full/v24/i25/2698.htm
DOI: https://dx.doi.org/10.3748/wjg.v24.i25.2698