Minimally invasive right hepatectomy for living liver donation: a systematic review of the literature

Living donor liver transplantation (LDLT) has emerged as one of the possible solutions for improving the donor pool. However, mainly in case of adult-to-adult donation, performing a right hepatectomy (RH) in a healthy individual should represent a challenge. A way for reducing this shortcoming is the use of mini-invasive surgery. The aim of the present study was, then, to perform a systematic review of the literature investigating the results of the laparoscopic right lobe donation, mainly looking at the different surgical methodologies adopted and the donor complication rates. A systematic search was done following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines: 176 articles were initially screened: eventually, 32 articles were identified, with a total of 501 investigated cases. Pure laparoscopic and robotic right hepatectomies were done in 84 (16.8%) and 14 (2.8%) donors, respectively. Hybrid or assisted procedures were done in 199 (39.7%) and 204 (40.7%) cases, respectively. In the 464 cases in which the postoperative course was exhaustively described for each patient, a total of 85 (18.3%) subjects experienced at least one complication. Twenty-six (5.6%) individuals had a grade III according to the Clavien-Dindo classification: no cases of organ dysfunction nor death were experienced. After stratification of the entire population according to the type of laparoscopic approach adopted (pure-robotic vs. hybrid-assisted), it was interesting to observe that hybrid-assisted cases presented an increased risk of experiencing any complication after RH, with an odds ratio (OR) of 2.53 (P value=0.01). Laparoscopic RH for living donation is a safe procedure. After 501 reported procedures, no deaths have been described. Pure laparoscopic approaches look to consent a lower risk of donor complication respect to hybrid ones. More studies comparing the different laparoscopic approaches with the open procedure are required.