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World J Gastrointest Surg. Jul 27, 2021; 13(7): 668-677
Published online Jul 27, 2021. doi: 10.4240/wjgs.v13.i7.668
Robotic donor hepatectomy: Are we there yet?
Ashwin Rammohan, Mohamed Rela
Ashwin Rammohan, Mohamed Rela, Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
Author contributions: Rammohan A and Rela M contributed to conception and design, acquisition, analysis and interpretation of data, drafted the article, revised it critically for important intellectual content; Rela M gave the final approval of the version to be published.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ashwin Rammohan, FACS, FRCS, MCh, Surgeon, Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, CLC Works Road Chromepet, Chennai 600044, India. ashwinrammohan@gmail.com
Received: February 8, 2021
Peer-review started: February 8, 2021
First decision: March 30, 2021
Revised: April 9, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: July 27, 2021
Processing time: 164 Days and 17.3 Hours
Abstract

In living donor liver transplantation (LDLT) the safety of the live donor (LD) is of paramount importance. Despite all efforts, the morbidity rates approach 25%-40% with conventional open donor hepatectomy (DH) operations. However, most of these complications are related to the operative wound and despite increased self- esteem and satisfaction in various quality of life analyses on LD, the most common grievance is that of the scar. Performing safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole team. Due to the ramifications the donor operation carries for the donor, the recipient, the transplant team and for the LDLT program in general, the development and acceptance of minimally invasive DH (MIDH) has been slow. The robotic surgical system overcomes the reduced visualization, restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to reproducibility. However, many questions especially with regards to standardization of surgical technique, comparison of outcomes, understanding of the learning curve, etc. remain unanswered. The aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH, appreciating the existing challenges and its future role.

Keywords: Liver transplantation; Donor hepatectomy; Minimal invasive surgery; Robotic surgery; Outcomes

Core Tip: While pioneering attempts are necessary in surgery to allow the development of expertise, the use of technologies in progressively sophisticated procedures must be carefully monitored and gradually implemented to ensure patient safety. The robotic surgical system overcomes reduced visualization, restricted range of motion and physiological tremor associated with conventional laparoscopic surgery. However, robotic donor hepatectomy needs to be evaluated carefully in experienced hands and a cautious approach is crucial, as even one untoward event in the donor surgery may significantly set back progress.