Robotic Versus Open Right Lobe Donor Hepatectomy for Adult Living Donor Liver Transplantation: A Propensity Score–Matched Analysis

Abstract

Robotic right lobe donor hepatectomy (RRLDH) is rarely performed, and data concerning its safety and efficacy are lacking. Here we compare our series of RRLDHs with a similar cohort undergoing open right lobe donor hepatectomy (ORLDH) with a propensity score-matched (PSM) analysis. Among 263 consecutive adult patients undergoing right lobe living donor hepatectomy from January 2015 until July 2019, 35 RRLDHs were matched to 70 ORLDHs. A 1:2 PSM analysis was performed to make the groups comparable for donor sex, age, and body mass index (BMI) and for recipient sex, age, BMI, Model for End-Stage Liver Disease score, and indication for transplant. Operative time was longer in RRLDHs compared with ORLDHs (504 ± 73.5 versus 331 ± 65.1 minutes; P < 0.001) but significantly decreased with the number of patients (P < 0.001). No conversions occurred. First warm ischemia time was longer and blood loss significantly less in RRLDHs (P = 0.001 and 0.003, respectively). Overall donor complications were similar: 2 (6%) in RRLDHs versus 12 (17%) in ORLDHs (P = 0.13). Biliary leak occurred in 1 (3%) patient receiving a robotic procedure and 2 (3%) patients receiving the conventional approach. Donors undergoing robotic surgery required less patient-controlled analgesia and had a shorter hospital stay compared with the open surgery group (P < 0.001 and P = 0.001, respectively). No significant differences in graft anatomical data and recipient outcomes were recorded. RRLDH is feasible, safe, and reproducible, with significantly decreased blood loss and a shorter hospital stay compared with the open procedure. The first 35 patients receiving the robotic procedure showed a substantial reduction in operative time, reflecting a rapid shortening of the learning curve.

Robotic Liver Surgery – Current Standards and Future Perspectives

“…While no differences were noted for postoperative complications, the robotic approach resulted in less blood loss and lower postoperative pain scores compared with the open procedure as well as better donor satisfaction with cosmetic results and body image when compared with the laparoscopic procedure. These results were confirmed by Broering et al in a series 263 consecutive adult patients undergoing right lobe living donor hepatectomy, of which 35 robotic and 70 open procedures were included in a propensity score matched analysis [49]. The safety (no conversion, all grafts successfully transplanted) was demonstrated and it was revealed that the robotic approach was associated with equally low complications, reduced blood loss, diminished uses of patient-controlled analgesia and a shorter hospital stay.…”

Robotic donor hepatectomy: Are we there yet?

“…The robotic platform also has the added benefits of overcoming restrictions in range of motion, physiological tremor and a limited field of vision. The high resolution amplified 3D image, tremor filtration and additional degrees of freedom of instruments allow for meticulous tissue handling, precise dissection and easier suturing capabilities[ 13 - 15 , 29 , 44 ]. All of which are important pre-requisites of a safe LD operation.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…They found 2 studies suggesting the superiority of machine learning techniques to standard liver scoring modalities for liver graft outcome. • Robotic donor hepatectomy: Broering et al 59 Thirty-five live liver donors undergoing robotic-assisted right hepatectomy were compared with propensity-matched (1:2) donors with open donor right hepatectomy. Donor complications were similar.…”

“…Importantly, donors undergoing robotic surgery required less patient-controlled analgesia and had a shorter hospital stay compared with the open surgery group. 59 The group from Yonsei University College of Medicine, Seoul, South Korea, also reported the comparison among robotic living donor right hepatectomy (n = 52), conventional open donor right hepatectomy (n = 62), and laparoscopy-assisted donor right hepatectomy (n = 118). They reported that the robotic method resulted in less blood loss compared with that of the open method.…”