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World J Gastroenterol. Jul 7, 2018; 24(25): 2698-2709
Published online Jul 7, 2018. doi: 10.3748/wjg.v24.i25.2698
Minimally invasive donor hepatectomy, are we ready for prime time?
Kin Pan Au, Kenneth Siu Ho Chok
Kin Pan Au, Department of Surgery, Queen Mary Hospital, Hong Kong, China
Kenneth Siu Ho Chok, Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
Author contributions: Chok KS proposed the study; Au KP and Chok KS conducted the literature review and wrote up the manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenneth Siu Ho Chok, Master of Surgery, Associate Professor, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. chok6275@hku.hk
Telephone: +86-852-22553025 Fax: +86-852-28165284
Received: March 29, 2018
Peer-review started: March 30, 2018
First decision: May 17, 2018
Revised: May 25, 2018
Accepted: June 9, 2018
Article in press: June 9, 2018
Published online: July 7, 2018
Processing time: 97 Days and 21.8 Hours
Abstract

Minimally invasive surgery potentially reduces operative morbidities. However, pure laparoscopic approaches to donor hepatectomy have been limited by technical complexity and concerns over donor safety. Reduced-wound donor hepatectomy, either in the form of a laparoscopic-assisted technique or by utilizing a mini-laparotomy wound, i.e., hybrid approach, has been developed to bridge the transition to pure laparoscopic donor hepatectomy, offering some advantages of minimally invasive surgery. To date, pure laparoscopic donor left lateral sectionectomy has been validated for its safety and advantages and has become the standard in experienced centres. Pure laparoscopic approaches to major left and right liver donation have been reported for their technical feasibility in expert hands. Robotic-assisted donor hepatectomy also appears to be a valuable alternative to pure laparoscopic donor hepatectomy, providing additional ergonomic advantages to the surgeon. Existing reports derive from centres with tremendous experience in both laparoscopic hepatectomy and donor hepatectomy. The complexity of these procedures means an arduous transition from technical feasibility to reproducibility. Donor safety is paramount in living donor liver transplantation. Careful donor selection and adopting standardized techniques allow experienced transplant surgeons to safely accumulate experience and acquire proficiency. An international prospective registry will advance the understanding for the role and safety of pure laparoscopic donor hepatectomy.

Keywords: Laparoscopic donor hepatectomy; Living donor liver transplantation; Minimally invasive surgery

Core tip: Reduced-wound donor hepatectomy has been developed to bridge the transition to pure laparoscopic donor hepatectomy, offering some advantages of minimally invasive surgery. To date, pure laparoscopic donor left lateral sectionectomy has been validated for its safety and advantages, while pure laparoscopic approaches to major left and right liver donation have been reported for their feasibility in expert hands. Careful donor selection and adopting standardized techniques allow experienced transplant surgeons to accumulate experience in this complex procedure. An international prospective registry will advance the understanding for the role and safety of pure laparoscopic donor hepatectomy.