Laparoscopic left lateral sectionectomy in living liver donors: From the first experience to routine usage
Artem Monakhov1, Konstantin Semash1, Olga Tsiroulnikova2, Timur Djanbekov1, Khizri Khizroev1, Nikita Kurtak1, Sergey V. Gautier1,2.
1Surgical Department #2, V. I. Shumakov National Medical Research Center of Transplantology and Artificial Organs, Moscow, Russian Federation; 2Sechenov First Moscow State Medical University, Moscow, Russian Federation
Background: Since 2002, when D. Cherqui described the first laparoscopic left lateral sectionectomy (LLS) in living donor, the safety of LLS laparoscopic procurement has been proven in a series of studies around the world. At the same time, today only a few hospitals use this method routinely.
In this study, we compared the laparoscopic and open approaches in living donor left lateral sectionectomy (LLS) and assessed the safety and potential of the laparoscopic approach. The learning curve of this procedure has been assessed as well.
Methods: 247 relative living donor LL sectionectomies were performed at National Medical Research Center of Transplantology and Artificial Organs from May 2016 to February 2020. Of these, 103 were pure laparoscopic procedures, which represented the subject of this study. Also, 144 open living donor LL sectionectomies performed during the same period were studied as a comparison group. Linear and broken-line regression models were used to access the learning curve.
Results: There were significant differences between the laparoscopic and open LLS groups (P < 0.001) in terms of blood loss (96.8 ± 16.5 vs 155.8 ± 17.8 mL) as well as the length of hospital stay (4 ± 0.4 vs 6.9 ± 0.5 days).
Linear regression analysis proved a significant decrease in the time of procedure during the study. The breakpoint of the broken-line regression model of learning curve was at 46's operation.
Conclusion: Laparoscopic approach in LLS living donation is a feasible and efficacious. It’s probably can be used as a “golden standard” for living donor LL sectionectomy procedure.
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