Background : While laparoscopic donor hepatectomy is becoming more prevalent, the outcomes of pure laparoscopic donor right hepatectomy (PLDRH) are still under-reported. This study aimed to present outcomes and experience of PLRDH in a large-volume single center.

Methods : This retrospective study included 310 living donors undergoing PLRDH between November 2014 and August 2023 at Asan Medical Center in Seoul. Postoperative complications of donors and recipients were assessed based on Clavien-Dindo classification and multivariate logistic regression analyses were performed to identify donor risk factors for recipient complications.

Results : This study shows postoperative outcomes of 310 PLDRH donors and corresponding recipients. One donor (0.3%) required open conversion and there was no mortality. There were two donors (0.65%) with major complications (Clavien-Dindo grade III) including intra-abdominal bleeding and wound problem. There were no biliary or vascular complications of donors. Regarding recipient outcomes, there were 66 cases (21.3%) of major biliary complications and 38 cases (12.3%) of major vascular complications. Multivariate analaysis showed donor risk factors for biliary stricture in recipients were graft weight (P = 0.017, OR 1.003, 95 % CI 1.001–1.006) and donor risk factor for recipient hepatic vein complications were graft weight (P = 0.026, OR 1.004, 95 % CI 1.001–1.008) and the presence of inferior right hepatic veins (P = 0.048, OR 2.402, 95 % CI 1.007–5.729).

Conclusions : PLDRH is a feasible and safe surgical procedure when performed at a highly experienced transplant center. To avoid biliary and vascular complications of donor, meticulous laparoscopic techniques and preoperative and accurate intraoperatieve anatomical assessment are essential.