Introduction: The use of laparoscopic procedures for liver transplantation (LT) remains controversial. This study aimed to present our preliminary experience with a minimally invasive pediatric living donor liver transplantation (LDLT).
Methods: The medical records of pediatric patients who underwent laparoscopy-assisted LDLT, namely laparoscopic mobilization of the diseased liver followed by open explant hepatectomy and graft implantation using an upper midline incision at Beijing Friendship Hospital between November 2019 and March 2023, were retrospectively reviewed, focusing on demographics and pre-, intra-, and postoperative outcomes. 
Results: Laparoscopy-assisted LDLT was successfully performed in all 13 pediatric patients. The mean total operative time was 478 min (range, 315-615 minutes), the median portal vein clamping time was 47 min (range, 33-107 minutes), the average time required to remove the liver was 229 min (range, 115-357 minutes), and the median cold ischemia time was 85 min (range, 29-214 minutes). The intraoperative course for all the recipients was uneventful. All patients recovered well without any significant acute postoperative problems, with only one patient presenting with hepatic artery thrombosis on postoperative day 1 who made a good recover after immediate thrombectomy and re-anastomosis. During a median follow-up of 41.8 (range, 24.3–64.3 months), all recipients survived with 100% graft survival. 
Conclusion: This is the world's largest single-center cohort study of pediatric laparoscopy-assisted LDLT using an upper midline incision. Our results provide preliminary evidence for the safety and feasibility of minimally invasive LDLT in selected pediatric patients, which may be a reasonably compromised strategy before attempting pure laparoscopic LT.