Robotic liver donor right hepatectomy: A pure, minimally invasive approach

Abstract

Right hepatectomy for a living liver donor via a pure minimally invasive approach is a challenging procedure and only a few cases have been reported. Between May 2013 and August 2015, 13 patients underwent robotic living donor right hepatectomy in our institute, and 54 patients received open surgery. In this series, no conversion was conducted for robotic donor right hepatectomy. The 2 groups shared similar blood loss (169 versus 146 mL), complication rates (7.7% versus 9.3%), and recovery of donor liver function (peak alanine aminotransferase, 269 versus 252 IU/mL). The robotic group needed longer operation time (596 versus 383 minutes) but less postoperative patient-controlled analgesia (0.58 versus 0.84 ng/kg) and a shorter period before returning to work/school (52.9 versus 100.0 days) and sex (100.0 versus 156.0 days). For recipient outcomes regarding the donor procedure, the robotic group shared similar experiences in early allograft dysfunction, complications, and 1-year recipient liver function with the open group. With respect to documented benefits of minimally invasive left-sided liver donor procedure, the development of right donor hepatectomy is slow. In conclusion, with substantial improvements in patient recovery after the minimally invasive approach, the robotic platform would be a big step toward completing pure minimally invasive liver donor surgery. Liver Transplantation 22 1509-1518 2016 AASLD.

Robot-Assisted Transplant Surgery - Vision or Reality A Comprehensive Review

“…While the operative time in live donor right hepatectomy is significantly longer compared with open procedures, there is no difference in complication rates, blood loss, and postoperative function of the liver remnant [2,45]. Decreased overall morbidity and intensive care unit and hospital stay are in favor of laparoscopic procedures while the operation per se adds tremendously to treatment cost, especially in the case of robotic systems being used.…”

“…Live donor right hepatectomy has become the most common procedure in living related adult-to-adult liver transplantation (LTx) and is a widely accepted alternative to deceased donor LTx [11,39]; however, there are concerns regarding the safety of healthy volunteer live organ donors [2]. Complication rates of living liver donors range between 16 and 34% [40].…”

“…A recent review suggested that robotic liver resection is at least comparable to both open and laparoscopic procedures based on outcome [44]. No differences between robotic and open donor right hepatectomy but less postoperative pain control associated with pneumonia in favor of the robotic procedure were described [2,4].…”

“…Pancreatic transplantation (PTx) is the only method to restore physiological glycemic control and prevent progression of comAuthor Reference Live liver retrieval Chen [2] 13 (right lobe) Giulianotti [43] 1 (right lobe) Wu [71] 1 (left lobe) plications in diabetic patients [46]. Refinements in surgical technique and immunosuppressive therapy have considerably improved outcome; however, the complication rate remains still at about 25% [47].…”

Use of robotics in liver donor right hepatectomy

“…No open conversion occurred in our first 15 consecutive cases, in which 13 donors underwent right hepatectomy. All donors had uneventful perioperative course, except one delayed bile leak after the patient was discharged (23).…”