Korean J Transplant.  2023 Nov;37(Suppl 1):S313. 10.4285/ATW2023.F-9253.

Surgical outcomes of laparoscopic donor hepatectomy performed by fellowship-trained surgeons: a comparative study with the expert surgeon

• Cho CW
• Choi Gs
• Kim KS

• KMID: 2551942
• DOI: http://doi.org/10.4285/ATW2023.F-9253

Abstract

Background
Implementation of laparoscopic donor hepatectomy (LDH) is still limited to the experienced surgeons. In 2019, Seoul guideline recommends that LDH should be performed by surgeons with expertise in open and laparoscopic liver resection and living donor liver transplantation (LDLT). However, our fellowship-trained surgeons (FTs) achieved to perform LDH independently by a proctored training through cognitive task analysis. The aim of our study is to compare the surgical outcomes of donor and recipient who underwent LDH and LDLT, respectively, performed by between the expert and two FTs, and to evaluate safety of LDH conducted by surgeons without the previous experience of open donor hepatectomy.
Methods
From December 2016 to December 2022, a total of 393 LDLTs for LDHs, performed by single expert (n=357) and two FT (n=33) surgeons, were included in the study. We compared 90-day surgical outcome of donor and recipient between the expert and FT groups.
Results
There was no open conversion of LDH in expert and FT group. Operation time of LDH in FT group was significantly longer than the expert (227 min vs. 382 min; P<0.001). In the donor cohort, there was no significant differences in major complication (grade III) rate between the expert versus FT groups (4.2% vs. 2.8%; P=0.260). In the recipient cohort, there was significant differences of hepatic vein complication (1.4% vs. 8.3%; P=0.029) and bile leakage (10.6% vs. 25%; P=0.026).
Conclusions
Cognitive task analysis of laparoscopic liver resection was beneficial for FTs to understand and perform complex procedure of LDH. With specific proctored training, FTs could conduct LDH safely based on donors outcomes. However, further studies with more cases are necessary to confirm the safety of LDH from FTs in terms of recipient outcomes.