Learning curve of laparoscopic living donor right hepatectomy

Background The feasibility and learning curve of laparoscopic living donor right hepatectomy was assessed. Methods Donors who underwent right hepatectomy performed by a single surgeon were reviewed. Comparisons between open and laparoscopy regarding operative outcomes, including number of bile duct openings in the graft, were performed using propensity score matching. Results From 2014 to 2018, 103 and 96 donors underwent laparoscopic and open living donor right hepatectomy respectively, of whom 64 donors from each group were matched. Mean(s.d.) duration of operation (252 center dot 2(41 center dot 9) versus 304 center dot 4(66 center dot 5) min; P < 0 center dot 001) and median duration of hospital stay (8 versus 10 days; P = 0 center dot 002) were shorter in the laparoscopy group. There was no difference in complication rates of donors (P = 0 center dot 298) or recipients (P = 0 center dot 394) between the two groups. Total time for laparoscopy decreased linearly (R-2 = 0 center dot 407, beta = -0 center dot 914, P = 0 center dot 001), with the decrease starting after approximately 50 procedures when cases were divided into four quartiles (2nd versus 3rd quartile, P = 0 center dot 001; 3rd versus 4th quartile, P = 0 center dot 023). Although grafts with bile duct openings were more abundant in the laparoscopy group (P = 0 center dot 022), no difference was found in the last two quartiles (P = 0 center dot 207). Conclusion Laparoscopic living donor right hepatectomy is feasible and an experience of approximately 50 cases may surpass the learning curve.