Introduction : Decreased blood loss, less postoperative pain, shorter length of stay in hospital, and excellent cosmetic outcome have well been validated as the advantage of laparoscopic hepatectomy. However, donor safety is the most important issue in living donor hepatectomy. Hence, pure laparoscopic right lobe donor hepatectomy has been applied in donors with favorable hepatic vascular and biliary anatomy.

Methods : We present the experiences for totally laparoscopic right hepatectomy in living donors with bile duct anomalies. From May 2016 to November 2017, totally laparoscopic right lobe donor hepatectomy for adult-to-adult living donor liver transplantation was performed in 24 cases. Among them, right hepatic ducts with more than 2 orifices were demonstrated in 11 patients.

Results : By Nakamura classification, type 2 anomaly was identified in 5 patients, type 3a in 3 patients, and type 3b in 3 patients, respectively. All donors were recovered without vascular or biliary complication. Biliary complications occurred in four cases of 24 recipients. Anastomosis site stricture of hepatic duct was confirmed in 3 cases (1 case in type 1, 1case in type 2, and 1 case in type 3b). And bile leakage from anatomosis site was identified in one case (type 3a). All complicated recipients was improved by biliary stents by endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic biliary drainage.

Conclusions : Conclusively, totally laparoscopic living donor right hepatectomy is feasible and acceptable in donors with bile duct anomaly. But, to become a routine procedure, further evaluation and long-term results by highly experienced surgeons should be demanded.