Living donor left lateral sectionectomy: Should the procedure still be performed open?

The chronic shortage of organs makes the option of living liver donation particularly appealing, and living donor LLS transplantation remains the most common procedure for pediatric liver transplantation in Russia. Laparoscopic living donor left lateral sectionectomy (lapLDLLS) was recently established as a new standard practice. The present retrospective single center study aimed to achieve a greater understanding of when the conventional method could be suitably substituted with the laparoscopic approach and to review the potential advantages obtained. Herein, we describe our experience from the initial implementation to routinely use of the laparoscopic approach. A retrospective review of 127 lapLDLLSs performed between May 2016 and August 2020 at the National Medical Research Center of Transplantation and Artificial Organs, Moscow, Russia was undertaken. A segmented line regression model and receiver operating characteristic analysis based on the operation time were used to determine the learning curve (LC) under the initial proctorship. Donors were divided into two groups: before and after attaining the LC, cases 1–37 and cases 38–127, respectively. The perioperative parameters of donors and recipients in post LC cases were compared to 154 open procedures with propensity score match 1:1. LC cutoff was determined to occur by the 37th case of lapLDLLS. Subsequently, for the lapLDLLS group compared to the open group, there were significant reductions in the operative time, estimated blood loss, visual analogue pain score on the first and fourth postoperative day, and length of hospital stay (p < 0.001 for each of the comparisons). There were no significant differences between the groups with respect to donor complication rates and recipient outcomes. The laparoscopic approach could be chosen for LLS living donors after achieving the LC, in circumstances where there is a well-developed and proctored program.

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