Introduction : This study is designed to analyze the feasibility of laparoscopic living donor right hemihepatectomy in living donors with portal vein variation.

Methods : Living donor liver transplantation cases with right liver graft during the period of January 2014 to September 2019 were included. Computed tomographic angiographies of the donor were three-dimensionally reconstructed, and the anatomical variation of the portal vein was classified. To reduce, selection bias, 1:1 ratio propensity score match analysis between the laparoscopy group and the open group was performed. Surgical and recovery-related outcome as well as portal vein complication-free survival, graft survival and overall survival were analyzed

Results : After matching, 171 cases in each group from 444 original cases were compared. The laparoscopy group had shorter operation time (P<0.001), smaller number of additional opioids required by the donor (P<0.001), shorter hospital stay. (P<0.001) There were no difference in the portal vein complication-free survival (P=0.16), graft survival (P=0.26), and overall survival. (P=0.53) While portal vein complication-free survival was inferior in portal vein other than type I (P=0.01), the laparoscopy showed similar portal vein complication-free survival whether the portal vein was type I (P=0.35) or other types. (P=0.30)

Conclusions : Laparoscopic living donor right hemihepatectomy can be performed as safely as open surgery regardless of the anatomical variation of portal vein.