Pier Cristoforo Giulianotti, MD; Fabio Sbrana, MD; Francesco Maria Bianco, MD; Enrico Benedetti, MD, FACS
Living donor liver transplantation represents a valid alternative to cadaveric one. It has the advantage of good quality grafts, prompt availability and better timing/scheduling of surgery. After an extensive experience in robotic-assisted major liver resections, we have developed this approach also for living donor right hepatectomy.
The patient presented in this video is a 53 year old healthy male, identified as a suitable donor for his brother. A minimally invasive robotic-assisted right hepatectomy was performed without any vascular clamping. The main surgical steps were: hepatic hilum dissection without vascular resection, hepatocaval plane dissection and parenchymal transection followed by section of the pedicle and hepatic vein. The right lobe was extracted through a 10 cm suprapubic midline incision.
The procedure was completed robotically with no conversion and no intraoperative morbidity. Operative time was 520 minutes. Estimated blood loss were 800 cc. The postoperative course was uneventful and the patient was discharged on postoperative day 7. The recipient was successfully transplanted without major complications.
Minimally invasive robotic assisted living donor right hepatectomy is feasible and safe. Robotic assistance allows an accurate hilar dissection, a better control of minor bleeding during the parenchymal transection on the perfused liver. Minimally invasive approach can potentially increase the percentage of organ donation.