Technique of robotic right donor hepatectomy

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Organ Transplantation

Background:

• Minimally invasive right donor hepatectomy (RDH) faces limited adoption due to surgeon concerns.
• Key challenges include bleeding during transection, right hepatic duct (RHD) division, and donor duct management.
• A simplified robotic RDH technique evolved over 144 cases is described.

Purpose of the Study:

• To describe a simplified robotic technique for right donor hepatectomy (RDH).
• To address and overcome common challenges in minimally invasive RDH.
• To present a refined approach based on extensive case experience.

Main Methods:

• Robotic right lobe mobilization performed clockwise, from right triangular ligament to hepatocaval ligament.
• Liver transection utilizes bipolar diathermy and monopolar shears, with laparoscopic CUSA assistance.
• Indocyanine green cholangiography guides RHD division with robotic scissors; remnant duct is sutured.

Main Results:

• The described technique facilitates a simplified robotic right donor hepatectomy.
• The approach aims to mitigate primary concerns associated with RDH, such as bleeding and duct management.
• Successful retrieval of the right lobe with an intact vascular pedicle was achieved.

Conclusions:

• The presented robotic RDH technique is adaptable with current robotic instruments.
• Further advancements in robotic platforms could establish robotic RDH as a standard of care.
• This simplified technique offers a potential pathway to increased adoption of minimally invasive RDH.