Extended criteria donors for robotic right hepatectomy: A propensity score matched analysis

Abstract

Background: Robotic right donor hepatectomy (RDH) has been reported from experienced centers with reduced morbidity when compared to open RDH. However, outcomes in donors with large grafts/complex biliovascular anatomy are unknown.Methods: Out of 170 robotic RDH, 100 had one or more of the following: graft weight ≥800 g, type 2/3 portal vein, >1 bile duct or hepatic artery and inferior hepatic veins >5 mm requiring reconstruction (extended criteria donors [ExRDH]), while the remaining 70 had standard anatomy (SRDH). After propensity score matching, 66 ExRDH were compared with 66 SRDH. Additionally, all robotic RDH performed were analyzed in three temporal phases (60, 60, and 50).Results: Peak AST and ALT were higher amongst donors and recipients in the ExRDH arm compared to SRDH. Other intraoperative parameters and postoperative complications were similar between the two groups. During the last phase, donors demonstrated reduction in duration of surgery, postoperative complications, and hospital stay while recipients showed decreased blood loss and hospital stay. Conclusion:Robotic right hepatectomy performed in donors with extended criteria have similar perioperative outcomes as standard donors. However, a significant learning curve needs to be traversed. Further studies are required before safely recommending robotic RDH for all donors.

What Is the Current Role and What Are the Prospects of the Robotic Approach in Liver Surgery?

“…Nevertheless, the first robotic liver resection was already reported in 2006, and thereafter, the usage of robotic liver surgery has increased rather quickly due to the acquired experience in laparoscopy since the early 1990s [ 8 , 9 ]. In the meantime, an expansion of the indications for robotic liver surgery has taken place, from wedge resections and segmentectomies in the initial phase, to hemi liver resections, extended hemi liver resections, posterosuperior segmentectomies, donor liver resections, and ALLPS in the present day [ 10 , 11 , 12 ].…”

Robotic and laparoscopic right lobe living donation compared to the open approach: A multicenter study on 1194 donor hepatectomies

“…These results are almost in line with those reported by a large series of robotic LDLT, reporting HAT rates ranging from 1.5 to 3%, with the higher incidence observed in case of grafts with known risk factors (eg, grafts weight > 800 g with nonmodal anatomy, requiring different types of vascular and biliary reconstructions). [29] However, a significant learning curve must be accomplished by performing over 15 cases compared to what has been predicted by others. [36] It was seen that the flattening of the learning curve can only be observed after a substantial number of cases, estimated to be at least 120, and could also significantly decrease the already minimal donor morbidity rates.…”

“…[24] Since then, more and more reports have been published showing the feasibility and safety of this approach. [25][26][27][28][29][30] Our study aims to assess the safety and feasibility of robotic right lobe donor hepatectomy compared to the fully Laparoscopic Right Lober donor hepatectomy (LRLDH) and the open (ORLDH) approaches from the database of 6 referral centers, using the propensity score-matched (PSM) analysis during 6 years of activity.…”

Approach to minimally invasive donor hepatectomy: Laparoscopic, robotic, or bit of both!

“…Such extended‐criteria donors do constitute a substantial portion of live donors, where robotic platform, with its capability to control bleeding in deeper planes and tackle biliary variations with accuracy, may possibly offer several advantages over laparoscopy. Indeed, centres with the robotic platform have expanded their selection criteria early on to include all donors suitable for open donor hepatectomy 3 . Thirdly, laparoscopy is labour intensive with the need to train multiple members to initiate and successfully perform MIDH.…”