Local researchers said they have confirmed the safety and effectiveness of pure laparoscopic liver resection compared to open right hepatectomy (ORH) in liver transplantation.
The liver transplant team, led by Professor Suh Kyung-suk at the Seoul National University Hospital’s Hepatobiliary and Pancreatic Surgery Department, recently published the follow-up results of 894 people who donated their livers from 2010 to 2018.
According to the Center for Korean Network for Organ Sharing (KONOS), the number of living donors of the liver increased 7.4 percent on-year to 1,188 in 2019. The number has continued to rise in the past five years, putting the average number of living liver donations at 22.9 per 1 million people in Korea. The figure is significantly higher than 1.6 per 1 million in the U.S., 0.7 in Germany, 0.4 in Italy, and 0.33 in the U.K.
Pure laparoscopic right hepatic resection is getting increasingly popular worldwide because it can minimize wounds, pain, and bleeding of a liver donor in consideration of the donor’s functional and cosmetic preferences.
However, as pure laparoscopic surgery is one of the most difficult surgeries, it has been available only in several institutions. No study has shown its safety and effectiveness objectively and sufficiently.
To evaluate the pure laparoscopic hepatectomy’s safety and usefulness, the SNUH’s research team performed one-on-one propensity score matching between the pure laparoscopic right hepatectomy and conventional ORH groups. Then, the team compared and analyzed the 198 donor-recipient pairs.
The results showed that the pure laparoscopic right hepatectomy took a longer operational time than ORH. Still, the two groups did not demonstrate a significant difference in the rate of complications in donors. The research team also found that the pure laparoscopic right hepatectomy shortened the postoperative hospital stay length.
Complication rates in recipients were similar between the two groups. However, the rates of early and late biliary complications in recipients were higher in the laparoscopic hepatectomy group. The researchers said they needed further studies on recipients’ long-term biliary complication outcomes.
“This study is meaningful because it is the first large-scale study to compare the pure laparoscopic right hepatectomy with ORH in liver transplant surgeries,” Suh said.
Professor Hong Suk-kyun of the SNUH said the study would provide objective evidence for utilizing pure laparoscopic donor right hepatectomy.
The study has been published in the latest issue of Annals of Surgery.
The SNUH said it became the world’s first to perform over 300 pure laparoscopic donor right hepatectomies last year since the first one in 2015. About 85-90 percent of donor hepatectomy is performed in pure laparoscopic surgeries at the hospital now.
In the early stage, pure laparoscopic surgery used to take more than six hours. However, the operation time has been reduced to about four hours, similar to open hepatectomy. Pure laparoscopic surgery does not require blood transfusion because bleeding is minimal. It also minimizes liver damage and keeps liver disease levels at bay.