Feasibility of gallbladder preservation during robotic left hepatectomy:A retrospective comparative study

Objective:Traditionally,gallbladder is routinely removed during left hepatectomy even if there is no gallbladder pathology.However,adverse consequence after cholecystectomy,though rare,still occa-sionally occurs.This study aims to evaluate the feasibility of gallbladder preservation during robotic left hepatectomy.Methods:All consecutive robotic left hepatectomy cases between December 2010 and January 2022 in Prince of Wales Hospital,the Chinese University of Hong Kong were retrieved from a prospectively collected database.The gallbladder was preserved by moving the liver transection line just away from the gallbladder fossa.Patients were divided into two groups:gallbladder preservation(GBP)and non-gallbladder preservation(NGBP).Operative results and long-term outcomes were compared between these two groups.Results:There were 11 cases in the GBP group and 25 cases in the NGBP group.The two groups were comparable in terms of the patient demographics and disease characteristics.There was no operative mortality.There was no difference between the two groups in operative time(GBP 270 min vs.NGBP 332 min,p=0.132),blood loss(GBP 50 mL vs.NGBP 150 mL,p=0.115)or complication rate(GBP 27.3%vs.NGBP 24.0%,p>0.999).There was also no difference in 5-year overall survival.In the GBP group,no patient developed specific symptoms or complications related to the preserved gallbladder.Follow-up ultrasound or computed tomography revealed a normal appearance of the preserved gallbladders except in one patient who developed a 3-mm gallbladder polyp.On the other hand,one(4%)patient in the NGBP group developed troublesome diarrhoea after surgery.Conclusion:Gallbladder preservation is safe and feasible during robotic left hepatectomy.The preserved gallbladder does not lead to any symptoms,while postcholecystectomy diarrhoea can be avoided.

Right or left hepatectomy: a continuing question in the era of pure laparoscopic donor hepatectomy

We read with great interest the article by Fujiki et al.published in the Annals of Surgery(1),which advocates for the use of a left liver graft with a pure laparoscopic donor hepatectomy(PLDH)approach to reduce the burden on living donors.Minimally invasive techniques,including laparoscopic surgery,have been increasingly adopted in donor hepatectomy for liver transplantation.This reflects a broader trend in various surgical fields to enhance patient outcomes both cosmetically and functionally.Since the first report of a PLDH in the form of a left lateral sectionectomy in 2002(2),this approach has expanded to include full left and full right hepatectomies(3,4).With advancements in laparoscopic instruments and growing experience,PLDH has become a standard practice for left lateral section grafts,as recognized by the most recent international consensus guideline(5).However,PLDH for full left and full right grafts has not yet reached the same level of acceptance.Predominantly performed in Asian countries,PLDH for these grafts highlights differences in donor and recipient characteristics compared to Western countries.Further studies and evidence are required to confirm the safety and feasibility of PLDH for full left and full right grafts on a broader scale.