Living Donor Right Hepatectomy Using the Hanging Maneuver by Glisson's Approach Under the Upper Midline Incision

The purpose of this study was to introduce an advanced technique for the best living donor right hepatectomy (LDRH) using the hanging maneuver by Glisson's approach under an upper midline incision. From January 2005 to February 2010, a total of 196 consecutive LDRHs have been performed at the National Cancer Center, Korea. To assess the overall outcomes of LDRH done with two significant technical developments-the upper midline incision and the initial Glisson's approach-we performed a comparative analysis involving all consecutive living donors, who we divided into three groups based on the two technical modifications over 5 years. Compared with the previous two groups, the third group of 32 consecutive living donors, from September 2009 to February 2010, demonstrated shorter operative time, shorter duration of hospital stay, and lower complication rate with no operative mortality, major morbidity, blood transfusion, or reoperation. All donors were fully recovered and returned to their previous activities. This LDRH using the hanging maneuver by Glisson's approach can be completed safely and effectively with good outcomes through an upper midline incision above the umbilicus, which may be a new milestone toward the best LDRH that donor surgeons can pursue.