Pediatric Liver Transplant FAQ on Laparoscopic Liver Donor Surgery

What is laparoscopy?

Laparoscopy is a minimally invasive surgical procedure in which clinicians manipulate surgical tools through tiny holes in the body. A small video camera and a light on the end of the tools enable surgeons to visualize the internal operating area. The camera projects an image on a screen so that clinicians can observe their progress while they work. With laparoscopy, surgeons can perform a full-scale procedure without having to make a large incision. Many surgeries today are routinely performed using laparoscopy, such as gallbladder removal, appendectomy, colon surgery, hernia surgery, and gynecological procedures.

What are the advantages of laparoscopy?

Patients who undergo laparoscopy spend considerably less time in the hospital and recuperate more quickly than those who undergo a major, open surgery. They also experience less pain and avoid the scarring of an open procedure.

How is laparoscopy used in liver transplants?

Laparoscopy can be used in liver transplants when there is a living donor who is in good health and is a good match for a recipient. Traditionally, doctors have relied on major open procedures as a way to remove a portion of the donor’s liver. This may require the donor to be hospitalized for as much as two weeks and then recuperate at home for two or three months. However, with a laparoscopic procedure, the donor may spend a week or less in the hospital and recover much faster. The liver quickly regenerates itself, typically in about six weeks. The liver is the only organ in the body with this self-regenerative capacity.

Is laparoscopy a common option for living donors in liver transplants?

In South Korea and some other Asian countries, laparoscopy is commonly used in living donor liver transplants. However, in the United States, it is rarely offered as an alternative because it is a technically challenging procedure that requires considerable training and experience. Stanford Medicine Children’s Health is one of a handful of medical centers in the United States that offer the laparoscopic option to living donors. Transplant surgeon Andrew Bonham, MD, a highly experienced clinician, pioneered this procedure at Stanford. Dr. Bonham is the director of Live-Donor Liver Transplantation at Stanford and oversees the intestinal transplant program at the medical center. He is collaborating with Kazunari Sasaki, MD, who has extensive experience in the procedure and joined our team in 2021. Dr. Sasaki hopes to begin a training program at Stanford to help increase the number of clinicians skilled in the laparoscopic procedure for living liver donors.

What’s involved in the procedure?

It takes two highly skilled surgeons to perform the procedure. One may manage the three-dimensional camera, which gives surgeons a full view of the surgical site and helps them navigate around delicate tissues. There are many blood vessels around and within the liver, so bleeding may occur during liver surgery. Laparoscopy is commonly used in liver surgery to remove tumors or cysts. In this case, surgeons may temporarily tie off blood flow to the organ to ease the process. However, when laparoscopic surgery is used to retrieve liver tissue for transplant, it’s critical to maintain blood flow to the organ so that it remains viable. This makes the procedure doubly challenging. 

Why is laparoscopy important in living donor liver transplants?

The process of donating a portion of a liver is an enormous commitment. It requires an otherwise healthy person to undergo a surgical procedure that is not without its risks. On the other hand, an individual is providing a great service to another in donating a portion of their liver. The waiting list for livers is a long one, and many patients die before they can receive a suitable organ. We hope that by offering donors the option of a laparoscopic approach, more potential donors will come forward and enable more of our patients to receive these lifesaving transplants.