Safety and Outcome of 248 Consecutive Robotic Donor Hepatectomy, Single Center Experience

Abstract

Introduction: The first robotic living donor right hepatectomy was reported by Giulianotti et al. in Chicago, USA in 2011. Since then, only few centers successfully introduced robotic living donor hepatectomy programs (Taiwan, Saudi Arabia, Korea, and China). The robotic surgical system and instruments have multiple advantages over the available conventional laparoscopic devices; it offers better visualization, the best ergonomics, a better range of movements, and reduced physiological tremors. Moreover, the amplified 3-D view with steady instrumental movements ensured meticulous tissue handling, precise parenchymal dissection, and easier suturing abilities. Methods & results: King Faisal Specialist Hospital and Research Center is considered the largest single center Living Donor Liver Transplant (LDLT) program in the region with >150 LDLT per year. A proctored program of Robotic donor hepatectomy has been started in our center since November 2018. Since November 2018 until December 2020 , 248 robotic donor hepatectomies have been performed with only 2 donors (0.8%) converted to an open approach. Ninety three grafts were left lateral segments for pediatric liver transplant, 51 were left lobes and 104 were right lobes. During the same time period, only 6 right lobe donors were performed with open approach due to logistic reasons and no anatomical variations were considered as a reason for open approach. All left lateral segments and left lobe grafts in our center since the beginning of the robotic program (November 2018) were performed robotically. No donor deaths were observed. No major complications (grade >III Clavian-Dindo) were recorded. Five donors had temporary bile leaks; none of them required any further intervention rather than keeping the drain longer time. Overall morbidities in the robotic donors were 7.2 % with average hospital stay 4days. Conclusions: Our abstract shows that robotic donor hepatectomies is safe, feasible and reproducible in the hand of experienced surgeon.