Current Topics in TransplantationLiver transplantationComparison of Upper Midline Incision With and Without Laparoscopic Assistance for Living-Donor Right Hepatectomy

•This study compared the benefits and shortcomings of an upper midline incision (UMI) for LDRH with versus without laparoscopic assistance.•The results showed that a UMI without laparoscopic assistance can provide feasibility, safety, effectiveness, and cosmetic outcomes for LDRH similar to the hybrid technique, and with less in-hospital cost, and may therefore be considered as the first-line incision of choice for LDRH.

BackgroundSince minimally invasive procedures for living-donor right hepatectomy (LDRH) became popular in recent years, several studies comparing the outcomes of donors undergoing an upper midline incision (UMI) under laparoscopic assistance for LDRH with those undergoing the traditional open LDRH have been published. However, there are very few comparative studies of outcomes for a UMI for LDRH with and without laparoscopic-assistance. We designed the present study to compare the benefits and shortcomings of a UMI for LDRH with and without laparoscopic assistance.MethodsForty-eight patients in our center were included in the study: group hybrid (n = 28) versus group UMI (n = 20). Their surgical outcomes, postoperative course, and cosmetic outcomes were studied from medical records.ResultsNo differences existed between the 2 groups regarding their baseline characteristics except that group Hybrid had more donors with positive hepatitis B core antibody. No difference was observed in operative time, graft weight, warm ischemia time, blood loss, incision length, liver and coagulation function test results, postoperative complications, or cosmetic parameters. No deaths occurred in both groups. The length of postoperative hospital stay was similar for both groups, but the hospital cost was significantly lower for group UMI than for group hybrid (6,906.7 ± 777.4 USD vs 7,643.3 ± 918.6 USD; P = .005).ConclusionsAn UMI without laparoscopic assistance can be considered as the first-line incision of choice for LDRH.