Safety, Efficacy, and Results of Fully Laparoscopic Right Lobe Living Donor Liver Donation

Living donor liver transplantation (LDLT) is an essential strategy to address the shortage of organs, particularly in Eastern regions where cadaveric donation is limited. Minimally invasive procurement techniques, specifically pure laparoscopic donor right hepatectomy (PLDRH) for adult LDLT, have gained popularity due to their potential benefits in terms of donor early recovery and improved cosmetic outcomes. However, concerns regarding its safety have hindered the widespread adoption of PLDRH and the lack of consensus on the procedure highlights the need for standardized guidelines. This study aims to comprehensively examine the key aspects of PLDRH, focusing on donor selection and operative procedures, to improve its safety and efficacy. The authors emphasize the importance of donor safety and provide valuable insights into the technical challenges encountered during PLDRH. Donor selection criteria include specific anatomical features, as well as considerations for graft volume. The bile duct division, a technically challenging step, has been made safer by techniques such as Indocyanine-green fluorescence imaging other than intraoperative cholangiogram. Experience in both open and minimally invasive liver resection, as well as open LDLT, is crucial to ensure a smooth learning curve for surgeons performing PLDRH. Recent evidence, including studies from Korean centers, supports the safety and feasibility of PLDRH. Meta-analyses have shown comparable outcomes between laparoscopic and open approaches in terms of donor and recipient complications. Nevertheless, a minimum number of 60 PLDRH cases has been recommended to achieve standardization and optimize outcomes. PLDRH represents a safe and effective procedure for LDLT. Donor selection, meticulous operative techniques, and a standardized post-operative plan contribute to enhanced safety and efficacy. PLDRH is a valuable option in the field of LDLT, backed by increasing evidence and advancements in surgical expertise.