Left hepatic vein preferential approach (LHVPA) based on anatomy is safe and feasible for Laparoscopic Living Donor Left Lateral Sectionectomy.

BACKGROUND: Laparoscopic living donor left lateral sectionectomy (LLLS) has increased in popularity over the past decade. The purpose of this study was to assess the safety and feasibility of the left hepatic vein preferential approach (LHVPA) based on left hepatic vein anatomy for LLLS. METHODS: Data from 50 donors who underwent LLLS in Huashan Hospital from October 2016 to November 2019 were analysed retrospectively. Based on the classification of the left hepatic vein anatomy, the vein was defined as the direct import type, upper branch type or indirect import type. Subgroup analysis was performed to compare the outcomes between the LHVPA and non-LHVPA groups. RESULTS: All 50 patients underwent pure LLLS. The mean operative duration was 157.5±29.7 min. The intraoperative blood loss was 160.4±97.5 mL. No complications more severe than grade III occurred. LHVPA was applied in 13 cases while non-LHVPA was applied in 10 cases in direct import type and upper branch type. The operative duration was shorter in the LHVPA group than the non-LHVPA group (142.7±22.0 min vs 173.0±22.8 min, P=0.01). The intraoperative blood loss was reduced in the LHVPA group compared with the non-LHVPA group (116.2±45.6 mL vs 170.0±63.3 mL, P=0.02). The length of the left hepatic vein reserved extrahepaticly in the LHVPA group was longer than the non-LHVPA group (4.3±0.2 mm vs 3.3±0.3 mm, P=0.01). The reconstruction rate of the left hepatic vein of the graft in direct import type was less in the LHVPA group than the non-LHVPA group (0/8 vs 4/6). CONCLUSIONS: LHVPA based on the left hepatic vein anatomy is recommended inLLLS, as it can further increase the safety and the efficiency of surgery for suitable donors.