Technique of robotic right donor hepatectomy

Abstract

Background: Although minimally invasive right donor hepatectomy (RDH) has been reported, this innovation is yet to be widely accepted by transplant community. Bleeding during transection, division of right hepatic duct (RHD), suturing of donor duct as well as retrieval with minimal warm ischemia are the primary concerns of most donor surgeons. We describe our simplified technique of robotic RDH evolved over 144 cases. Patients and Methods: Right lobe mobilization is performed in a clockwise manner from right triangular ligament over inferior vena cavae up to hepatocaval ligament. Transection is initiated using a combination of bipolar diathermy and monopolar shears controlled by console surgeon working in tandem with lap CUSA operated by assistant surgeon. With the guidance of indocyanine green cholangiography, RHD is divided with robotic endowrist scissors (Potts), and remnant duct is sutured with 6-0 PDS. Final posterior liver transection is completed caudocranial without hanging manoeuvre. Right lobe with intact vascular pedicle is placed in a bag, vascular structures then divided, and retrieved through Pfannenstiel incision. Conclusion: Our technique may be easy to adapt with the available robotic instruments. Further innovation of robotic platform with liver friendly devices could make robotic RDH the standard of care in future.

Open to robotic right donor hepatectomy: A tectonic shift in surgical technique

“…The technique for r‐LDRH with da Vinci Xi robotic platform has been published previously 24 . Operation theater layout and port positions for r‐LDRH is depicted in Figure 2.…”

“…The technique for r-LDRH with da Vinci Xi robotic platform has been published previously. 24 Operation theater layout and port positions for r-LDRH is depicted in Figure 2. Briefly, there are four steps, namely, mobilization of the liver, hilar dissection, parenchymal transection, and graft retrieval.…”

Surgical techniques for robotic right donor hepatectomy, part 2: robotic parenchymal transection and bile duct division

“…Once the RHD is transected, the laparoscopic assistant inserts a grasper or suction catheter into the space previously created between the posterior liver and retrohepatic IVC. This grasper is used to lift the liver off of the IVC to facilitate transection of the remaining 1–2 cm of parenchyma, starting at the hilum and progressing in a cephalad direction [ 1 - 3 ]. Eventually, the grasper is inserted into the space between the right and middle hepatic vein and the final portion of the parenchymal transection is completed ( Fig.…”

Surgical techniques for robotic right donor hepatectomy, part 1: robotic hilar dissection and right lobe mobilization

“…The antero-superior surface of the RPV is then carefully teased off the hilar plate by gently pressing the RPV posteriorly with the Maryland forceps and sweeping the tissues off the vein with the scissors. It is important to mobilize the RHA off any attachments to the RPV to facilitate safe division of the RPV later in the procedure [1][2][3][4][5].…”

“…Robotic surgery is emerging as a feasible minimally invasive approach for donor hepatectomy [1][2][3][4]. Some of the most important parts of right donor hepatectomy are hilar dissection, right lobe mobilization and parenchymal transection.…”