Hand-assisted laparoscopic donor hepatectomy for living related transplantation in the porcine model

Use of a minimally invasive approach for donor nephrectomy has proven to be safe and feasible and has increased the pool of donors for living related renal transplantation. A porcine study to assess the safety and feasibility of performing laparoscopic donor hepatectomy was performed, with potential application to human liver donors for living related liver transplantation. Of the 10 50-kg pigs used, 2 underwent an open left lateral segmentectomy to define the pig anatomy. Two subsequent pigs underwent a laparoscopic liver resection to refine the technique. Subsequently, under sterile conditions, six pigs underwent laparoscopic liver resection with use of a hand-assisted technique for long-term study. Diameters and lengths of hepatic vessels and ducts were measured. Operative blood loss, operative time, and warm ischemia duration were noted. Biopsies of the resected specimens were done to look for ischemia. There was one operative death in the group with chronic liver failure, due to stapler misfire and hemorrhage from the left hepatic vein. The only instance of morbidity was a wound infection. The resected liver had minimal warm ischemia time and microscopic changes, which led us to believe that the organ was suitable for transplantation. We believe that this long-term study establishes the feasibility of this procedure.