Background : Purely laparoscopic right donor hepatectomy (PLRDH) in donors with anatomical variations is performed only in experienced centers because it is technically challenging and affects recipient outcomes. This video shares our experience performing PLRDH in a donor with anatomical variations of the portal vein and bile duct in a small center with limited experience.

Methods : In the first case, there was an anatomical variation in which the bile duct was type II, and the accessory segment 6 bile duct drained into the common hepatic duct. The second case had type III portal vein mutation. During PLRDH, 3D flexible endoscopy and real-time indocyanine green fluorescence cholangiography were used. The bile duct was divided using a cutting and suturing method, and the portal vein was divided using a Hem-O-Lok clip.

Results : The operative time in the first case was 420 minutes, two bile duct orifices were obtained. Both the donor and recipient were discharged on postoperative days (POD) 7 and POD 19, respectively, without any specific complications. The operative time in the second case was 425 minutes, the anterior and posterior branches of the graft’s portal vein were obtained separately. Both the donor and recipient were discharged on POD 7 and POD 24, respectively, without any specific complications.

Conclusions : In our experience, it is safe and feasible to perform pure laparoscopic right donor hepatectomy in donor cases with anatomic variations, even in small centers with limited experience.