Minimally Invasive Donor Hepatectomy in Living Donor Liver Transplantation—Evidence of Benefit?: A Systematic Review and Meta-analysis of Current Literature

摘要

Minimally invasive donor hepatectomy (MIDH) has become a key innovation in living donor liver transplantation, offering potential advantages like reduced postoperative pain, faster recovery, less scarring, and related chronic pain. This study conducted a systematic review and meta-analysis to evaluate the benefits of MIDH compared with conventional open donor hepatectomy (ODH). A systematic search of Medline, Web of Science, and Scopus up to June 17, 2024, was performed to identify studies comparing outcomes of liver donors undergoing ODH, laparoscopic-assisted donor hepatectomy (LADH), pure laparoscopic donor hepatectomy (PLDH), or robotic-assisted donor hepatectomy (RADH) for any type of liver graft procurement. Meta-analyses of available data were performed using random-effect modeling. Thirty-seven nonrandomized comparative studies, published between 2006 and 2024, were included, including 4429 ODH, 479 LADH, 1351 PLDH, and 1136 RADH cases. LADH did not show significant benefits over ODH in the case of major hepatectomy. PLDH and RADH were associated with reduced hospital stay (-0.6 to -1.5 d) and decreased blood loss (-76 to -117 mL). Pure MIDH (PLDH and RADH) also showed a reduced risk of Clavien-Dindo grade I complications in case of major hepatectomy. In conclusion, MIDH, particularly PLDH and RADH, offers advantages over ODH, including reduced blood loss, shorter hospital stays, and fewer minor complications, especially for major hepatectomies.