Fully Robotic Left Lobe Donor Hepatectomy is Safer Compared to Open

Objective: To compare the outcomes of fully robotic versus open left lobe donor hepatectomies, focusing on donor safety. Summary Background Data: Right lobe hepatectomies are traditionally preferred for adult liver transplants due to their larger graft size but may involve increased risks for donors. Left lobe hepatectomies are considered safer for donors but are less commonly used due to concerns about small-for-size syndrome in adult settings. Patients and Methods: We conducted an analysis of 339 living liver donors from a prospectively maintained registry at a single institution from November 2011 to June 2023, comparing 72 open and 267 robotic left lobe hepatectomies. Primary outcomes included donor complication rates until hospital discharge while secondary outcomes focused on hospital stay and recipient complications. Results: Robotic hepatectomy was associated with significantly less blood loss (mean 77 (SD 68) vs. 316 (SD 168) mL, P <0.001), lower donor morbidity 6% vs. 18%, P =0.003), and shorter hospital stay (3 vs. 5 days, P <0.001). Adult recipients receiving robotically retrieved donor grafts were associated with a lower overall morbidity rate (40% vs. 59%, P =0.033) compared to open. Conclusion: Robotic left donor hepatectomy significantly improves donor safety compared to the open approach, supporting its use as a less invasive and donor-centered option in living donor liver transplantation. This study, the largest known series of left lobe donor hepatectomies, demonstrates the robotic approach superiority, potentially setting a new standard in the field of living donor liver transplantation.