Standardizing Pure Laparoscopic Donor Hepatectomy (PLDH) - Expanding the First Largest Series from Indian Subcontinent

Introduction: Even after 2 decades of experience in laparoscopic hepatectomy, data on purely laparoscopic approach for donor hepatectomy in adult living donor liver transplantation (LDLT) is limited, especially from India. We report our series of 18 cases of pure laparoscopic donor hepatectomy from India, which is the largest reported series from the country. Method: We report our initial experience of a purely laparoscopic approach for donor hepatectomy for adult recipients to explore its potential application in the management of donors. A retrospective data analysis of 18 consecutive patients operated between Jan 2018 and October 2019 was done. Result: There were 16 right, 1 left hepatectomy and 1 left lateral sectionectomy. The median operative time was 486 minutes (range 294-684 minutes), and warm ischemia time was 6 minutes (4-12 minutes). Estimated blood loss was 300 mL (10-850 mL) and none of the patients required intraoperative transfusion. Two patients required conversion to Lap Assisted approach, due to unfavourable biliary anatomy. 2 patients had bile leak, both requiring ERCP and stenting and there was no mortality. Conclusion: Purely laparoscopic donor hepatectomy for adult LDLT recipients seems to be a feasible option; with careful patient selection and when performed by experienced surgeons, it may afford results comparable to the open method. Further evaluation, including long-term results, may support these preliminary findings of comparative outcomes for donors undergoing PLDH.