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

Mark Sturdevant,Dieter Broering,Ahmed Zidan

doi:10.20517/2394-5079.2021.111

Abstract

The application of minimally invasive liver surgery (MILS) in the field of living donor hepatectomy has been exceedingly slow, and its impact is limited to a handful of centers worldwide. Widespread adoption has been primarily hampered by the technical limitations of laparoscopy, namely rigid instrumentation, suboptimal optics, and a seemingly steep learning curve. These deficiencies are magnified in the donor hepatectomy operation wherein the parenchyma and vasculature must be handled atraumatically to produce a pristine allograft fit for implantation. Donor safety concerns and medicolegal ramifications are also cited as impediments to MILS in donor surgery. In 2013, our institution embraced a purely laparoscopic approach to living donor left lateral sectionectomy, and it quickly became our default technique. However, with donor hemi-hepatectomy, we gravitated to the robotic surgical system as our preferred modality. Herein, we describe our experience with minimally invasive donor hepatectomy, which we now universally offer to all living donors. Our extensive familiarity with robotic donor hepatectomy will provide the reader with an instructive perspective on the attributes and merits of the robotic approach. With appropriate collaboration and proctorship, we believe that the robotic platform will actualize a more rapid and widespread adoption than that experienced with the purely laparoscopic technique.

Highlights

In the early-to-mid 1990s, living donor liver transplantation (LDLT) was primarily developed to ameliorate waitlist mortality which resulted from an insufficient deceased donor pool
Even the most ardent proponent of LDLT acknowledged some unease with the inherent violation of primum non nocere, which occurs to some extent in every person undergoing living donor hepatectomy
Mitigating the violation of “first, do no harm” was the impetus for the application of minimally invasive liver surgery (MILS) to the field of living liver donation. This led Soubrane et al.[1] to complete the first laparoscopic donor left lateral sectionectomy (L-LLS) in 2002, but few early adopters followed in their footsteps

Summary

Introduction

In the early-to-mid 1990s, living donor liver transplantation (LDLT) was primarily developed to ameliorate waitlist mortality which resulted from an insufficient deceased donor pool. By 2011, Giulianotti et al.[8,9] had developed extensive experience in robotic liver surgery and utilized this approach to carry out the first robotic donor hepatectomy (RDH) when he procured a right lobe at the University of Illinois-Chicago via the da Vinci robotic system.

Results

Conclusion