Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation

Abstract

Living donation in many countries is the main resource of organs. Healthy, volunteering individuals deserve the highest safety standards possible in addition to the least invasive technique to procure the organs. Since the introduction of living donor liver transplantation, many efforts have been made to minimize the surgical trauma inherent to living donor surgery. The journey started with a large Mercedes incision and evolved to reverse L‐shaped and small upper midline incisions before the introduction of minimally invasive laparoscopic techniques originated. The technical difficulties of the laparoscopic approach due to suboptimal instrumentation, challenging ergonomics, and the long learning curve limited the application of the fully laparoscopic approach to a few centers. The recent introduction of the robotic platform with its superb optical system and advanced instruments allows for the first time, a genuine emulation of open donor surgery in a closed abdomen, thus allowing all liver donors to benefit from minimally invasive surgery (better cosmesis, less pain and morbidity, and better quality of life) without compromising donor safety. This attribute in combination with the ubiquitous presence of the robot in major transplant centers may well lead to the desired endpoint of this technology, namely, the widespread dissemination of minimally invasive donor surgery.

The Role of ICG in Robot-Assisted Liver Resections

“…Segments resected during ICG-supported RALS include more segments, which are usually considered difficult to reach. This mirrors the superiority of the robot in narrow spaces, especially compared to laparoscopic procedures, taking advantage of the superior visualization and dexterity [ 7 , 24 , 27 , 28 , 38 ]. ICG potentially supports the performance of precise surgery in these narrow spaces.…”

“…Very few intra- and post-operative complications were noted in both cohorts. This may be a reflection of the more precise and less harmful surgical approach, which improves the short-term outcome and quality of life [ 1 , 6 , 7 , 12 , 35 , 39 , 40 ].…”

“…The advantages of robotic surgery are well known, and robotic liver surgery has been proven to be safe [ 4 , 5 , 6 ]. Despite advantages such as steady and clear 3D visualization, superior ergonomics, and improved dexterity, a major limitation of robotic surgery is its lack of haptic feedback, so much so that the surgeon purely relies on the visual aspects [ 1 , 7 , 8 ]. In open hepatic surgery, an intraoperative ultrasound (IOUS) is mandatory to add precision and allow real-time intraoperative, strategic imaging [ 9 ].…”

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

“…This is especially important as living donor liver transplantation has become more widely performed. Minimally invasive donor hepatectomy has been reviewed, including robot-assisted living donor hepatectomy [ 64 ]. The first robot-assisted living donor hepatectomy was performed in 2012.…”

“…This procedure has not become widely used for several reasons, but it is becoming more available at specialized centers. These authors reviewed several reports, including a review of 13 robot-assisted donor hepatectomies reported from Taiwan [ 64 ]. In comparison with open living donor hepatectomies, they found similar blood loss, complication rates, and donor recovery time.…”