Background : Laparoscopic living donor hepatectomy (LLDH) has been on the rise with its advantages of lesser blood loss, lesser postoperative morbidity, shorter hospital stays and better cosmetic outcomes compared to open surgery. But, surgeons still face technical difficulties on details of operation field exposure. This study aimed to introduce various retraction techinques including double rubber band retraction which can efficiently expose the surgical plane in LLDH, and show the perioperative outcomes.

Methods : All patients underwent LLDH from September, 2021 to December, 2023 and were reviewed retrospectively. We applied various retraction methods, such as, barbed sutures or round loop retraction of cystic duct to expose the hilum, internal retraction using vessel loops and metal clips for vessel isolation, and double rubber band retraction to expose the parenchymal resection plane during liver resection.

Results : Out ot total 12, 7 male and 5 female patients were included. The mean age was 41 years (range, 25–57 years). The median intraoperative bleeding was 310 cc (range, 130–1100cc). The median operation time was 382 minutes (range, 375–555). There were only 3 patients (25.0%) with minor postoperative complications and no major complication. And the mean postoperative hospital stay was 7.0 (6-10 days) days.

Conclusions : Combinations of various retraction methods help to expose the surgical plane. Especially, double rubber band technique solved the insufficient traction of the dome and also hanging maneuver. Also combinations of already introduced retraction methods, we can ensure the safety of the donor and also procure an appropriate graft from living donors when even complicated anatomies are present.