To perform a minimally invasive donor hepatectomy (MIDH), both laparoscopic living donor right hemihepatectomy (LLDRH) and robotic living donor right hemihepatectomy (RLDRH) have been developed. However, there has been no comparative study of these two surgical methods. In a single institution, researchers for a study sought to compare the surgical results of LLDRH versus RLDRH.
A total of 171 individuals underwent MILH of the right liver from March 2016 to March 2022; the patients were separated into groups called RLDRH and LLDRH. All operations were done by two surgeons with knowledge of both methods. Learning curves were computed while comparing clinical traits, recipient and donor perioperative outcomes, and donor anatomic variances between the two groups. LLDRH was started at their institution in 2019; hence a subgroup analysis was carried out solely using donors acquired after that date.
For 102 and 69 patients, respectively, RLDRH and LLDRH were done. Although estimated blood loss was lower in RLDRH (104 vs. 238 mL, P = 0.002), the surgical duration was substantially greater for RLDRH than LLDRH (464 vs. 407 min, P< 0.001). Major difficulties occurred almost equally often in both groups. After 2019, substantially more RLDRH patients than LLDRH patients exhibited variations in the hepatic artery (14.3% vs. 2.9%, P = 0.020) and portal vein (16.1% vs. 4.3%, P = 0.027). While the learning curve for LLDRH stabilized right away, that for RLDRH took about 16 cases to stabilize.
Less intraoperative bleeding and similar postoperative results were seen with RLDRH compared to LLDRH. Additionally, since 2019, donors with anatomic differences in the hilar structure have used RLDRH more frequently. Based on their experience with a single center, they suggested that standardized RLDRH procedures assist in establishing pure minimally invasive donor hepatectomy procedures and facilitate the safe implementation of laparoscopic approaches.
Reference: sciencedirect.com/science/article/pii/S1743919122007774
