Clinical Report: Minimally Invasive Right Hepatectomy in Living Liver Donation
Overview
This meta-analysis evaluated postoperative outcomes of minimally invasive liver resection (MILR) versus open liver resection (OLR) for right hepatectomy in adult-to-adult living donor liver transplantation (A2ALDLT). Analysis of 15 retrospective studies including 2,094 donors showed MILR is associated with reduced intraoperative blood loss, shorter hospital stay, and comparable complication rates compared to OLR.
Background
Adult-to-adult living donor liver transplantation (A2ALDLT) using right hepatic lobe donation is a complex procedure with significant donor safety concerns, especially in Western countries. Minimally invasive liver resection (MILR) techniques have been increasingly adopted to potentially reduce surgical risks. While MILR has demonstrated safety in various liver diseases, its impact specifically in right lobe donation for A2ALDLT remains under investigation. This meta-analysis aims to clarify the comparative outcomes of MILR versus conventional open liver resection (OLR) in this setting.
Data Highlights
Outcome
MILR (n=553)
OLR (n=1541)
Effect Measure
95% CI
P Value
Duration of Surgery (minutes)
Data pooled
Data pooled
WMD
Not specified
NS
Intraoperative Blood Loss (mL)
Lower
Higher
WMD
Significant reduction
<0.05
Postoperative Transaminase Peak (AST/ALT)
Comparable
Comparable
WMD
Not significant
NS
Any Postoperative Complication
Similar rate
Similar rate
OR
Not significant
NS
Complications ≥ Dindo-Clavien IIIa
Similar rate
Similar rate
OR
Not significant
NS
Duration of Hospitalization (days)
Shorter
Longer
WMD
Significant reduction
<0.05
Key Findings
MILR for right hepatectomy in A2ALDLT donors significantly reduces intraoperative blood loss compared to OLR.
Postoperative hospital stay is shorter in donors undergoing MILR versus OLR.
There is no significant difference in operative time between MILR and OLR approaches.
Postoperative peak transaminase levels (AST and ALT) are comparable between MILR and OLR groups.
The overall rate of postoperative complications, including severe complications (Dindo-Clavien ≥ IIIa), does not differ significantly between MILR and OLR.
The quality of evidence is limited by retrospective study designs and potential bias.
Clinical Implications
Minimally invasive right hepatectomy appears to be a safe and effective alternative to open surgery for living liver donors, offering benefits such as reduced blood loss and shorter hospitalization without increasing complication rates. Surgeons experienced in MILR techniques may consider this approach to enhance donor recovery and safety. However, careful patient selection and surgical expertise remain critical given the complexity of A2ALDLT.
Conclusion
MILR for right lobe donation in adult living liver transplantation demonstrates favorable perioperative outcomes compared to open surgery, supporting its adoption in experienced centers. Further prospective studies are warranted to confirm these findings and optimize donor safety.
