Copyright ©The Author(s) 2023.
World J Gastrointest Surg. May 27, 2023; 15(5): 776-787
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.776
Table 1 Biliary duct and portal vein variations
Biliary duct variations

ANormal bifurcation (57%)
BTrifurcation of 3 ducts (12%)
CRight anterior (C1, 16%) or right posterior (C2, 4%) duct draining into common hepatic duct
DRight posterior (D1, 5%) or right anterior (D2, 1%) duct draining into left hepatic duct
EAbsence of hepatic duct confluence (3%)
FDrainage of right posterior duct into cystic duct (2%)
Portal vein variations
IClassical anatomy
IIIRight posterior vein as first branch of main portal vein
IVSegment VII branch separate branch of right portal vein
VSegment VI branch separate branch of right portal vein
Table 2 Clavien-Dindo classification for donor and recipient complications[55]
INon-life threatening. Requires only bedside interventions, postoperative bleeding requiring three units of packed red blood cells, no prolongation of hospital or ICU stay longer than twice the population median
IINo residual disability. Any complication that is potentially life threatening, or requires use of four units of packed red blood cells, or prolongation of hospital stay for > 4 wk or ICU stay for > 5 d
IIIResidual disability. Any complication with residual or lasting functional disability or development of malignant disease
IVLiver failure or death. Requires liver transplantation (grade IVA) or results in death (grade IVB)
Table 3 Reported complications of minimally invasive living donor hepatectomy
IFever, gastroenteritis, gastric ulcer, occipital alopecia, pneumothorax without drainage, wound infection, suprapubic hematoma, ileus, arm neuropraxia, atelectasis, transient neuropenia
IIGastroparesis, pulmonary infection, segment IV infarction, bile duct stenosis, pancreatitis, cystitis, incisional port-size hernia
IIIaBiliary leakage, fluid collection, bladder injury, portal vein thrombosis or stenosis
IIIbAbdominal abscess, intra-abdominal bleeding
Table 4 Barriers to global dissemination of minimally invasive donor hepatectomy

Institutional barriersDonor safety: concerns for compromised donor safety when using MIS approaches (e.g., control of bleeding, parenchymal transection). High-risk: donor morbidity and mortality can compromise institutional reputation and even suspension of living donor transplantation program. Limited evidence: existing studies selecting for most ideal patients
Surgeon-related barriersLearning curve: high surgical experience in both minimally invasive liver surgery and living donor hepatectomy. Limited MIS experience by liver surgeons. Transplant surgeons in some countries do not frequently practice HPB surgery
AccessibilityLocalization of expertise in very few centers worldwide. Need for proctoring by surgical experts to start MIDH program (e.g., fly in experts from specialist centers to proctor first cases, local surgeons fly to specialist centers to observe). Resources: need for specialized technology (e.g., CUSA)