Minimally Invasive Liver Transplantation: The Recipient Operation

The introduction of minimally invasive donor hepatectomy (MIDH) operation saw the initiation and incorporation of minimal access surgery into the field of liver transplantation (LT). Several studies, meta-analyses, and consensus guidelines have demonstrated the undisputed advantages of the MIDH operation. Given these positive trends, and the increasing acceptance and acknowledgment of the safety of MIDH among the transplant community, there has been an intuitive thrust to further push the boundaries of what was initially considered unfeasible - to that of the minimally invasive liver transplant recipient surgery (MIRS). Given its extremely steep learning curve and undefined safety profile, the MIRS procedure remains limited to less than a handful of LT units across the world. It does, however, appear inevitable that the MIRS is likely to be performed widely in the future. Nonetheless, embarking on such a project needs not only just a gifted and trained surgeon, but a focussed and united effort of the whole team. This article reviews the current evidence, debates the early trade-offs involved in the introduction of the operation, and importantly, presents a safe and structured algorithm for teams interested in embarking on this very complex, yet exciting new realm of LT.