Current Status of Minimally Invasive Surgery for Donor Hepatectomy: A Worldwide Survey (A Joint Initiative of the International Laparoscopic Liver Society and the International Living Donor Liver Transplantation Group)

Background: Minimally invasive donor hepatectomy (MIDH) is gaining exponential growth. This study aimed to investigate the global dissemination of MIDH and to identify strategies and barriers to implementing MIDH in centers performing living donor liver transplantation (LDLT). Methods: A web-based survey was distributed to members of the International Laparoscopic Liver Society, the International Living Donor Liver Transplantation Group, and centers performing LDLT identified through a systematic review. The survey included 5 sections: (1) General information, (2) Institutional LDLT activity in 2022 and MIDH adoption, (3) Technical aspects of MIDH, (4) Surgeon experience with LDLT and MIDH, and (5) Opinions on MIDH. Results: Seventy-six institutions participated, with 34 (44.7%) reporting active MIDH programs. In 2022, 32.6% of donor hepatectomies (1551/4774) were performed using a minimally invasive approach, including 25.9% of right, 48.4% of left, and 49.4% of left lateral hepatectomies. The adoption of MIDH exhibited regional differences, with active programs in 48.9% of Eastern centers compared with 37.9% of Western centers, although this difference did not reach statistical significance (P = 0.48). Regarding the surgical approach, in 2022, the majority of MIDHs were performed using robot assistance (63.9%), followed by pure laparoscopy (35.7%) and laparoscopic-assisted techniques (0.4%). Notably, 60% of centers performing robot-assisted donor hepatectomy had no prior experience in laparoscopic donor hepatectomy. Conclusions: In 2022, MIDH demonstrated a 44.7% penetration among LDLT centers, with nearly one-third of donors undergoing hepatectomy through a minimally invasive approach. Robotic surgery has emerged as a pivotal factor in facilitating the implementation of MIDH globally.