Laparoscopic Left Lateral Sectionectomy in Living Donors

Living donor liver transplantation has become a widely accepted alternative to cadaveric transplantation in children. The use of liver grafts from living donors provides similar or even better short-term graft function and long-term survival rates, especially in children, as compared with whole and split cadaver liver grafts.1,2 The number of children receiving liver grafts from living donors is increasing annually in our institution. This procedure is, however, limited by surgical risks brought upon donors. Left lateral sectionectomy performed through open approach is a well-standardized procedure, associated with a lower rate of complications and mortality than right hepatectomy in living donors for adult transplantation. In living donations for liver transplantation in children, optimizing the postoperative course and limiting abdominal wall injury, especially in those young donors, remain of special concern. Minimally invasive donor nephrectomy using laparoscopic techniques has been widely reported and appeared beneficial for the donor as compared with standard open surgery, decreasing the overall morbidity, and improving donors' quality of life at low cost3–5 without deleterious effects on recipient's long-term kidney function.6 Considering our acquired expertise in laparoscopic liver resection7,8 and our training of standard open surgery as well as liver graft harvesting in living donors, we decided to propose laparoscopic left lateral sectionectomy in donors for liver transplantation in children. Since describing its technical feasibility with the first 2 cases,9 we have developed this procedure and we are now able to assess its safety and reproducibility in our center. Furthermore, during the first period of our experience in graft harvesting for children, a standard open surgical approach was used. This initial experience allowed us to compare both techniques of left lateral section harvesting. The primary goals of the present study were to validate the safety and reproducibility of the laparoscopic technique within our department of surgery.