Systematic review and meta-analysis of open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy

Author:

Ziogas Ioannis A.1234ORCID,Kakos Christos D.4ORCID,Moris Dimitrios P.5ORCID,Kaltenmeier Christof6ORCID,Tsoulfas Georgios7ORCID,Montenovo Martin I.2ORCID,Alexopoulos Sophoclis P.2ORCID,Geller David A.6ORCID,Pomfret Elizabeth A.1ORCID

Affiliation:

1. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA

2. Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

3. Usher Institute, University of Edinburgh, Edinburgh, UK

4. Surgery Working Group, Society of Junior Doctors, Athens, Greece

5. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

6. Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

7. Department of Transplantation Surgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece

Abstract

The value of minimally invasive approaches for living donor hepatectomy remains unclear. Our aim was to compare the donor outcomes after open versus laparoscopy-assisted versus pure laparoscopic versus robotic living donor hepatectomy (OLDH vs. LALDH vs. PLLDH vs. RLDH). A systematic literature review of the MEDLINE, Cochrane Library, Embase, and Scopus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (up to December 8, 2021). Random-effects meta-analyses were performed separately for minor and major living donor hepatectomy. The risk of bias in nonrandomized studies was assessed using the Newcastle-Ottawa Scale. A total of 31 studies were included. There was no difference in donor outcomes after OLDH versus LALDH for major hepatectomy. However, PLLDH was associated with decreased estimated blood loss, length of stay (LOS), and overall complications versus OLDH for minor and major hepatectomy, but also with increased operative time for major hepatectomy. PLLDH was associated with decreased LOS versus LALDH for major hepatectomy. RLDH was associated with decreased LOS but with increased operative time versus OLDH for major hepatectomy. The scarcity of studies comparing RLDH versus LALDH/PLLDH did not allow us to meta-analyze donor outcomes for that comparison. There seems to be a marginal benefit in estimated blood loss and/or LOS in favor of PLLDH and RLDH. The complexity of these procedures limits them to transplant centers with high volume and experience. Future studies should investigate self-reported donor experience and the associated economic costs of these approaches.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation,Hepatology,Surgery

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