A systematic review and network meta-analysis of outcomes after open, mini-laparotomy, hybrid, totally laparoscopic, and robotic living donor right hepatectomy

A systematic review and network meta-analysis was performed to compare outcomes after living donor right hepatectomy via the following techniques: conventional open (Open), mini-laparotomy (Minilap), hybrid (Hybrid), totally laparoscopic (Lap), and robotic living donor right hepatectomy (Robotic). PubMed, EMBASE, Cochrane, and Scopus were searched from inception to August 2021 for comparative studies of patients who underwent living donor right hepatectomy. Nineteen studies comprising 2,261 patients were included. Operation time was longer in Lap versus Minilap and Open (mean difference 65.09 min, 95% confidence interval 3.40–126.78 and mean difference 34.81 minutes, 95% confidence interval 1.84–67.78), and in Robotic versus Hybrid, Lap, Minilap, and Open (mean difference 144.72 minutes, 95% confidence interval 89.84–199.59, mean difference 113.24 minutes, 95% confidence interval 53.28–173.20, mean difference 178.33 minutes, 95% confidence interval 105.58–251.08 and mean difference 148.05 minutes, 95% confidence interval 97.35–198.74, respectively). Minilap and Open were associated with higher blood loss compared to Lap (mean difference 258.67 mL, 95% confidence interval 107.00–410.33 and mean difference 314.11 mL, 95% confidence interval 143.84–484.37) and Robotic (mean difference 205.60 mL, 95% confidence interval 45.92–365.28 and mean difference 261.04 mL, 95% confidence interval 84.26–437.82). Open was associated with more overall complications compared to Minilap (odds ratio 2.60, 95% confidence interval 1.11–6.08). Recipient biliary complication rate was higher in Minilap and Open versus Hybrid (odds ratio 3.91, 95% confidence interval 1.13–13.55 and odds ratio 11.42, 95% confidence interval 2.27–57.49), and lower in Open versus Minilap (OR 0.07, 95% confidence interval 0.01–0.34). Minimally invasive donor right hepatectomy via the various techniques is safe and feasible when performed in high-volume centers, with no major differences in donor complication rates and comparable recipient outcomes once surgeons have mounted the learning curve.