Laparoscopic versus open living donor right hepatectomy using a propensity score matched analysis Ki-Hun Kim, MD, PhD Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

Abstract Background: Because donor hepatectomy is not a surgical procedure under pathological conditions, it is important to consider the quality of life such as postoperative pain or cosmetic effect. Therefore, laparoscopic donor hepatectomies with less postoperative pain and shorter hospital stay has been attracting attention recently and is being performed gradually in various centers. The aim of this study was to compare the result of pure laparoscopic living donor right hepatectomy (LLDRH) and conventional open living donor right hepatectomy (OLDRH) to evaluate the safety and efficacy of LLDRH. Methods: From November 2014 to November 2019, total of 90 cases of LLDRH and 1593 cases of OLDRH were performed. To minimize selection bias, 1:1propensity score (PS) matching was performed between the LLDRH and OLDRH cohorts. After PS matching, finally 90 patients were included in each group. Results: There was no open conversion and no reported complication during study period in LLDRH group. The operative time was significantly longer in LLDRH (364.82 ± 53.06 vs. 313.93 ± 86.51 min, p=0.000); however, the estimated blood loss was significantly much less in LLDRH (175.56 ± 47.24 mL vs. 283.89 ± 53.47 mL, p=0.000). The time to diet was faster in the LLDRH group (2.22 ± 0.54 vs. 3.00 ± 1.35 days, p=0.005). And the postoperative hospital stay was also shorter in the LLDRH group (8.19 ± 2.21 vs. 10.40 ± 3.20 days, p=0.000). Conclusions: The authors established reasonable indications to minimize donor complication in performing LLDRH and implemented them rigorously. Pure laparoscopic major donor hepatectomy is a surgical procedure that requires high proficiency due to anatomical complexity, therefore, it is strongly recommended that the procedure should be performed carefully by the reasonable criteria in the early stage of performing the surgery and centers with higher complications than open donor hepatectpmy.