Background : Pure laparoscopic living donor hepatectomy become the trend in experienced centers. Although including the caudate lobe to the left liver graft (LLG) has certain advantages, it has rarely been performed in a pure laparoscopic approach due to the technical intricacies. Here, we report a successful case series of pure laparoscopic left hepatectomy with caudate lobectomy for living donor liver transplantation.

Methods : The LLG and caudate lobe were fully mobilized through the left-side approach. The IVC ligament was divided using a large hemolock. After diving the Aratius’ ligament, the middle and left hepatic vein trunk was isolated with a 9 Fr-sized relation tube for hanging maneuver. A significant caudate vein was isolated for outflow reconstruction. The left portal vein was carefully isolated to avoid damaging the caudate branch. The spiegel lobe and paracaval portion of the caudate lobe were included in the LLG.

Results : Ten patients underwent a pure laparoscopic living donor left hepatectomy with caudate lobectomy. The median donor age was 37 (31–44) years, and all patients were male. The median BMI was 27.8 (25.6–37.2) kg/m². The estimated volume of the caudate lobe was 30 (22–48) gm, and the corresponding GRWR was 0.05 (0.03–0.10). Actual graft volume and GRWR were 460 (447–665) gm and 0.84 (0.72–0.96), respectively. The operation time was 395 (295–445) minutes. All patients recovered without specific postoperative complications, and hospital stay was 6 (6–7) days.

Conclusions : Pure laparoscopic living donor left hepatectomy with caudate lobectomy is technically feasible and offers a significant additional graft volume for LLG with precarious GRWR.