The first international consensus statement on the step-by-step techniques of laparoscopic and robotic surgery for living liver donors has been published.
A joint research team led by Professor Jongman Kim of the Department of Transplantation Surgery at Samsung Medical Center and Professor Kwang-Woong Lee of the Division of Hepatobiliary and Pancreatic Surgery at Seoul National University Hospital outlined specific techniques and key considerations for minimally invasive donor hepatectomy. The work came out of discussions jointly organized by the International Living Donor Liver Transplantation Group (iLDLT) and the International Laparoscopic Liver Society (ILLS). The findings were published in the latest issue of the international journal HepatoBiliary Surgery and Nutrition (HBSN).
Living donor liver transplantation is a procedure in which part of a healthy donor's liver is removed and transplanted into a patient. Minimally invasive donor surgery using laparoscopic or robotic techniques offers several advantages over open surgery, including less pain, smaller scars, and faster recovery. However, minimally invasive donor hepatectomy demands a high level of surgical expertise, because surgeons must precisely handle the blood vessels and bile ducts of both the graft to be transplanted and the liver remaining in the donor.
Previous international consensus statements focused mainly on selection criteria for donors and medical centers and on surgical outcomes, offering limited guidance on the actual steps of the procedure. To address this gap, the iLDLT and ILLS combined clinical experience and the existing literature on minimally invasive donor hepatectomy to set out step-by-step surgical techniques and precautions for surgeons to reference.
Thirty-six experts from 12 countries, nominated by the two societies, took part. Beginning with an initial online meeting in July 2025, the group drafted consensus statements on minimally invasive surgical techniques. In October of that year, the statements were discussed and put to an on-site vote at the 7th World Congress of the iLDLT in Shanghai, China. The level of agreement was then confirmed through a separate validation by 10 additional international experts.
The consensus statement covers:
▲ Patient positioning and port placement
▲ Hilar dissection of the vessels and bile duct entering the liver
▲ Parenchymal transection
▲ Bile duct division
▲ Vascular division and graft retrieval
▲ Anesthesia and pain management
"This consensus is significant in that it provides a practical reference standard for minimally invasive donor hepatectomy that liver transplant teams and surgeons can use when introducing or expanding these procedures," said Professor Jongman Kim. "Through multicenter research, we will continue to share our surgical experience and help ensure that minimally invasive surgery expands safely."
Publication Information
Title: iLDLT-ILLS experts meeting for surgical techniques in minimally invasive donor hepatectomy
Journal: HepatoBiliary Surgery and Nutrition (IF = 8.1)
Co-first author: Jongman Kim, Department of Surgery, Samsung Medical Center