Robotic donor hepatectomy: Are we there yet?

Abstract

In living donor liver transplantation (LDLT) the safety of the live donor (LD) is of paramount importance. Despite all efforts, the morbidity rates approach 25%-40% with conventional open donor hepatectomy (DH) operations. However, most of these complications are related to the operative wound and despite increased self- esteem and satisfaction in various quality of life analyses on LD, the most common grievance is that of the scar. Performing safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole team. Due to the ramifications the donor operation carries for the donor, the recipient, the transplant team and for the LDLT program in general, the development and acceptance of minimally invasive DH (MIDH) has been slow. The robotic surgical system overcomes the reduced visualization, restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to reproducibility. However, many questions especially with regards to standardization of surgical technique, comparison of outcomes, understanding of the learning curve, etc. remain unanswered. The aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH, appreciating the existing challenges and its future role.

Application of robotics in abdominal organ transplantation: A bibliometric analysis

“…Table 3 shows that the majority of the most‐cited articles about robots in transplantation are centred on kidney transplantation. Conversely, more experience has yet to be acquired in robotics applied to pancreatic and liver transplantation 9,33–36 . However, considering the technical complexity in both liver and pancreatic living donation, robot assistance may expand the applicability of the minimally invasive approach in these fields because of its enhanced precision and ergonomics, 34,37 and the future integration of imagining modalities as well as the ability to analyse data collected by the robotic systems.…”

Preventing Small-for-size Syndrome in Living Donor Liver Transplantation: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference

“…70 Although there is currently no evidence to suggest that minimally invasive donor hepatectomy impacts on the SFSS in the recipients, caution should be exercised in selecting these donors because an SFSG in this setting may also be associated with additional graft factors, including longer donor warm ischemia time, short vessels, and potentially higher biliary complications. [71][72][73] As part of the donor factors, the working group also reviewed the evidence for donor ethnicity as a variable influencing SFSS. Although there are reports that Eastern population when compared with the Western have a higher percentage of body fat for a specified BMI (different BMI cutoff compared with west), higher rates of hepatic macrosteatosis, lean (nonobese) nonalcoholic fatty liver disease, lower liver regenerative potential, different transplant indications, and recipient acuity, there is currently no evidence to suggest that the donor ethnicity has an impact on SFSS in the recipient.…”

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

“…Another series reviewed compared 25 robot-assisted and 50 laparoscopic donor hepatectomies with comparable results. In another review, the authors evaluate results from centers worldwide comparing open, conventional laparoscopic, and robot-assisted donor hepatectomy [ 65 ]. These authors trace minimally invasive donor hepatectomy.…”