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

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], 2006c		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], 2011f	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], 2013l	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], 2016s			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
			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.