• J Rhu, G-S Choi, Kwon C H D CHD 0000-0002-1082-3321 Department of General Surgery, Digestive Disease and Surgery Institute, Lerner College of Medicine, Cleveland Clini, J M Kim, and J-W Joh.
• Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea.
• Br J Surg. 2020 Feb 1; 107 (3): 278-288.

BackgroundThe feasibility and learning curve of laparoscopic living donor right hepatectomy was assessed.MethodsDonors who underwent right hepatectomy performed by a single surgeon were reviewed. Comparisons between open and laparoscopy regarding operative outcomes, including number of bile duct openings in the graft, were performed using propensity score matching.ResultsFrom 2014 to 2018, 103 and 96 donors underwent laparoscopic and open living donor right hepatectomy respectively, of whom 64 donors from each group were matched. Mean(s.d.) duration of operation (252·2(41·9) versus 304·4(66·5) min; P < 0·001) and median duration of hospital stay (8 versus 10 days; P = 0·002) were shorter in the laparoscopy group. There was no difference in complication rates of donors (P = 0·298) or recipients (P = 0·394) between the two groups. Total time for laparoscopy decreased linearly (R2  = 0·407, β = -0·914, P = 0·001), with the decrease starting after approximately 50 procedures when cases were divided into four quartiles (2nd versus 3rd quartile, P = 0·001; 3rd versus 4th quartile, P = 0·023). Although grafts with bile duct openings were more abundant in the laparoscopy group (P = 0·022), no difference was found in the last two quartiles (P = 0·207).ConclusionLaparoscopic living donor right hepatectomy is feasible and an experience of approximately 50 cases may surpass the learning curve.© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.

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