Improved Short-Term Outcomes With Fully Robotic Recipient Adult Living Donor Liver Transplantation

Objective: To compare short-term outcomes between open and fully robotic adult recipient living donor liver transplantation (LDLT). Summary Background Data: LDLT remains a challenging procedure, traditionally performed using the open approach. Recent advancements in robotic surgery offer potential benefits, including enhanced precision, and reduced invasiveness. Methods: This study compared two adult-to-adult recipient LDLT groups: 453 open cases and 54 fully robotic cases. Multivariable linear regression analysis was conducted to identify independent predictors of morbidity, as captured by the Comprehensive Complication Index ® (CCI ® ). Results: Robotic recipient liver transplantation was associated with lower median blood loss (650 vs. 2,000 ml, P <0.001), shorter ICU (3 vs. 5 d, P <0.001) and hospital stay (14 vs. 20 d, P =0.030), and fewer infection rates (9.3% vs. 42.8%, P <0.001), when compared to open. The CCI ® was significantly lower in the robotic group (15.0 vs. 20.9, P =0.045). Graft survival at 6 months was 98.1% in the robotic vs. 91.8% in the open group ( P =0.080), while recipient survival was superior in the robotic group (100% vs. 91.8%, P =0.040). Conclusions: Fully robotic recipient LDLT is feasible and safe, with potential benefits including reduced morbidity, faster recovery, and shorter hospital stay. These findings support broader adoption of robotic techniques in liver transplantation, pending further cost-effectiveness studies and randomized controlled trials.