Laparoscopic left lateral sectionectomy for living liver donation: the Ghent University experience
The first laparoscopic living donor liver transplantation (LDLT) was described in 2002, and since then, this procedure has taken to be accepted because of technical difficulties and demanding surgical skills. Left lateral sectionectomy is the graft of choice for pediatric LDLT. Our technique of laparoscopic left lateral sectionectomy for LDLT in herein described. From January 2009 to March 2017, 11 pure laparoscopic left lateral sectionectomies for living donor liver donation have been performed in our institution. The transection line followed the trans-umbilical approach. Warm ischemia was 4 minutes and the total cold ischemia less than 3 hrs. Dietary intake was started from the first post-operative day. Complications have been recorded in 2 (16.6%) donors: 1 necrosis of segment IV needing antibiotic therapy and one fluid collection on the section edge treated conservatively. Analgesics drugs have been administered through a central line during the first 48 hrs. The median length of hospital stay was 4 days. Major indications in recipients were: Biliary atresia (n=8), primary oxaluria, cholestatic syndrome and multifocal HCC on a cirrhotic liver from unknown origin (one case each). One child died because of a fungal sepsis following retransplantation due to graft dysfunction. Biliary complications requiring percutaneous dilations and/or revision of the anastomosis have been recorded in 4 (36%). Laparoscopic left lateral sectionectomy for pediatric LDLT is a safe and feasible procedure having the potential benefit of lowering donor morbidity rates. Its reproducibility should be further validated.