Evaluation of the Learning Curve for Pure Laparoscopic Donor Right Hepatectomy by Analyzing 115 Consecutive Cases in an Experienced Adult Living Donor Liver Transplant Center

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Abstract

Introduction

Few experienced centers have reported the results of pure laparoscopic donor right hepatectomy. Recently, pure laparoscopic donor right hepatectomies are performed without any selection criteria in our center. The aim of this study is to evaluate center-based learning curve for pure laparoscopic donor right hepatectomy.

Method

Data from 122 donors who underwent pure laparoscopic donor hepatectomy at Seoul National University Hospital from November 2015 to June 2017, including 115 donors who underwent right hepatectomy, were retrospectively analyzed. Periods were divided into two groups based on the first year.

Result

There were 64 donors in initial period and 51 in recent period. No donors required transfusion. The operative time and the time to remove liver were significantly shorter in recent period than in initial period (333.7 vs 293.6; P=0.001) (239.6 vs 215.6; P=0.005). The ΔHb% and ΔAST% were lower in recent period than in initial period (17.5 vs 14.9; P=0.042) (1316.6 vs 1048.9; P=0.009). The hospital stay was significantly shorter in recent period (8.3 vs 7.3; P=0.002). There were 1 case with grade III which required endoscopic biliary intervention and percutaneous drainage for biliary leakage and 2 cases with grade IV which required reoperation due to biliary stricture and bleeding. However, there were no complications more than grade III in recent period.

Conclusion

A center should be required to perform at least 60-70 cases of pure laparoscopic donor right hepatectomy to obtain stable surgical skill for this procedure.

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