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World J Gastrointest Surg. May 27, 2023; 15(5): 776-787
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.776
Global dissemination of minimally invasive living donor hepatectomy: What are the barriers?
Christos Dimitrios Kakos, Angelos Papanikolaou, Ioannis A Ziogas, Georgios Tsoulfas
Christos Dimitrios Kakos, Angelos Papanikolaou, Ioannis A Ziogas, Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
Christos Dimitrios Kakos, Georgios Tsoulfas, Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
Angelos Papanikolaou, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Ioannis A Ziogas, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Author contributions: Kakos CD, Papanikolaou A, Ziogas IA, and Tsoulfas G conceived and designed the study, acquired, analyzed, and interpreted the data, drafted and critically revised the manuscript, and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report having no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Chief Doctor, Doctor, Professor, Surgeon, Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, 66 Tsimiski Street, Thessaloniki 54622, Greece.
Received: November 9, 2022
Peer-review started: November 9, 2022
First decision: January 3, 2023
Revised: January 16, 2023
Accepted: March 15, 2023
Article in press: March 15, 2023
Published online: May 27, 2023

Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.

Keywords: Minimally invasive donor hepatectomy, Liver transplantation, Living donation, Laparoscopic donor hepatectomy, Global surgery

Core Tip: Living donor liver transplantation provides an excellent option for expanding the donor pool. Minimally invasive donor hepatectomy can potentially minimize complications of hepatectomy to the donors and have a better cosmetic effect. This approach demands expertise and experience in both liver surgery and minimally invasive techniques to maximize its potential.