Pure laparoscopic versus open living donor right hepatectomy using a propensity score matched analysis: challenge to 0% of complication

Background: Because donor hepatectomy is not a surgical procedure under pathological conditions, it is important to consider the quality of life such as postoperative pain or cosmetic effect. Therefore, laparoscopic donor hepatectomies with less postoperative pain and shorter hospital stay has been attracting attention recently and is being performed gradually in various centers. The aim of this study was to compare the result of pure laparoscopic living donor right hepatectomy (LLDRH) and conventional open living donor right hepatectomy (OLDRH) to evaluate the safety and efficacy of LLDRH. Methods: From November 2014 to October 2017, total of 38 cases of LLDRH and 907 cases of OLDRH were performed. To minimize selection bias, 1:1propensity score (PS) matching was performed between the LLDRH and OLDRH cohorts. After PS matching, finally 36 patients were included in each group.From November 2014 to October 2017, total of 38 cases of LLDRH and 907 cases of OLDRH were performed. To minimize selection bias, 1:1propensity score (PS) matching was performed between the LLDRH and OLDRH cohorts. After PS matching, finally 36 patients were included in each group. Results: There was no open conversion and no reported complication during study period in LLDRH group. The operative time was significantly longer in LLDRH (372.47 ± 53.06vs. 313.39 ± 47.79 min, p = 0.000); however, the estimated blood loss was significantly much less in LLDRH (175.56 ± 47.24 mL vs. 283.89 ± 53.47 mL, p = 0.000). The time to diet was faster in the LLDRH group (2.22 ± 0.54 vs. 3.00 ± 1.35 days, p = 0.005). And the postoperative hospital stay was also shorter in the LLDRH group (8.58 ± 1.95 vs. 10.17 ± 1.40 days, p = 0.000). Conclusion: Our study showed that LLDRH can be safely performed by a well-experienced surgeon in donors selected using strict indications.