Background : Laparoscopic donor hepatectomy for liver transplantation has recently come into widespread use. When compared with conventional open liver surgery, it has the advantages of reduced postoperative pain, shorter recovery time, and less surgical morbidity. The procedure is technically demanding and is available at only a few hospitals worldwide. This report is to share our initial experience of pure laparoscopic donor hepatectomy.

Methods : On December 7, 2021, we performed living donor liver transplantation with laparoscopic donor hepatectomy.

Results : The recipient was 48 years old male with hepatocellular carcinoma (within Milan criteria: 4.5cm sized / Solitary) and hepatitis B related liver cirrhosis (MELD : 11). The donor was son of patient and 25 years old male. BMI was 26.58(kg/m2). On preoperative evaluation, remnant liver volume percentage was 36% and graft to recipient weight ratio was estimated to 1.11. Donor steatosis was 10.9%. There was no anatomical variation. They were ABO incompatible. Graft type was modified right lobe graft. Pure laparoscopic donor hepatectomy was performed and 5 ports were used. Indocyanine green fluorescent imaging was applied to identify demarcation line and bile duct resection. The operation time was 305min and estimated blood loss was 300ml. Warm ischemic time was 41min and mean operation time of recipient was 600min. There was no packed RBC transfusion during operation. The donor discharged with no complication on postoperative day 5. The recipient had no postoperative complication and safely discharged on postoperative day 15.

Conclusions : The laparoscopic donor hepatectomy significantly reduces the invasiveness and morbidity of living donor liver procurement, shortening recovery times, improving quality of life, and potentially motivating more people to donate.