Outcomes of Robotic Living Donor Right Hepatectomy from 52 Consecutive Cases: Comparison with Open and Laparoscopy-assisted Donor Hepatectomy

Abstract

Objective: To investigate the feasibility and safety of an alternative robotic living-donor right hepatectomy (RLDRH) technique. Background data: Data for minimally invasive livingdonor right hepatectomy, especially RLDRH, in a relatively large donor cohort have not been reported yet. Methods: From March 2016 to March 2019, 52 liver donors underwent RLDRH. The clinical and perioperative outcomes of RLDRH were compared with those of conventional open donor right hepatectomy (CODRH; n=62) and laparoscopy-assisted donor right hepatectomy (LADRH; n=118). Donor satisfaction with cosmetic results was compared between RLDRH and LADRH using a body image questionnaire. Results: Although RLDRH had a longer operative time (RLDRH, 493.6 min; CODRH, 404.4 min; LADRH, 355.9 min, p< 0.001), its mean estimated blood loss was significantly lower (RLDRH, 109.8 mL; CODRH, 287.1 mL; LADRH, 265.5 mL; p< 0.001). The postoperative complication rates were similar among the three groups (RLDRH, 23.1%; CODRH, 35.5%; LADRH, 28.0%; p=0.420). Regarding donor satisfaction, the body image and cosmetic appearance scores were significantly higher in RLDRH than in LADRH. There was no significant difference in hospital stay among the three groups (p=0.105). After propensity score matching, RLDRH showed a shorter hospital stay and similar complication rate than CODRH. Conclusions: RLDRH resulted in a similar postoperative complication rate and shorter length of hospital stay compared with those of CODRH and provided better body image and cosmetic results compared with those of LADRH. RLDRH is feasible and can be safely performed by expert surgeons in both robotic systems and open hepatectomy.

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

“…With these maneuvers, we have not needed to convert to an open procedure due to bleeding or lack of progression during parenchymal transection. [37][38][39] Another criticism of the robotic system is the deliberateness in instrument exchange and how this could potentially impact the rapidity of hemostatic control in the case of significant bleeding.…”

“…Several centers have now successfully launched RLDH programs (Saudi Arabia, Korea, and Taiwan) and the early experience has been encouraging. 33,38,42,43 F I G U R E 1 Advantages of laparoscopy and the robotic platform in liver surgery The first series of robotic right lobe donor hepatectomy was published by Wu and colleagues from Taipei, who reported on 13 robotic donor hepatectomies and compared them with a historical group of 54 open living donor hepatectomy cases. This landmark proof-of-concept study demonstrated that the two groups had similar blood loss, complication rates, and donor recovery time.…”

“…In our recently published series, we described the closed and open jaw techniques which can be utilized with the Harmonic ultrasonic shear in order to deftly control the intraparenchymal pedicles and vessels. With these maneuvers, we have not needed to convert to an open procedure due to bleeding or lack of progression during parenchymal transection 37–39 …”

“…Widespread dissemination has been hampered by inaccessibility to the robotic system, concerns over donor safety, and cost. Several centers have now successfully launched RLDH programs (Saudi Arabia, Korea, and Taiwan) and the early experience has been encouraging 33,38,42,43 …”

Robotic donor hepatectomy: a niche advancement or the way forward? A perspective from the world’s largest center

“…This experience forms the basis of our profound enthusiasm and a hopeful prediction that we are at the threshold for global dissemination of minimally invasive surgery for liver donors. Multiple high-volume programs have been established; in addition to our group in Riyadh, Choi et al [19] and Rho et al [20] in Korea and Binoj et al [21] in India, have developed RDH expertise in countries highly dependent on LDLT. These success stories should embolden other primed institutions to pursue the robotic platform as their preferred MIDH modality.…”