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Updated: May 10, 2025

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
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Intermittent Inflow Occlusion in Robotic Right Donor Hepatectomy: A Randomized Controlled Trial.

Rahul D Kunju1, Christi Titus Varghese, Krishnanunni Nair

  • 1Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.

Annals of Surgery
|April 21, 2025
PubMed
Summary
This summary is machine-generated.

Intermittent inflow occlusion (IIO) during robotic right donor hepatectomy (RDH) is safe and reduces blood loss in donors. This technique also improves graft parameters in recipients post-transplant.

Keywords:
hepatectomyliver transplantationliving donorsminimally invasive surgeryrobot-assisted surgery

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Area of Science:

  • Minimally invasive surgery
  • Organ transplantation
  • Surgical oncology

Background:

  • Minimally invasive donor hepatectomy adoption is limited due to bleeding and warm ischemia challenges.
  • These challenges can lead to donor and recipient morbidity.
  • Robotic surgery offers potential solutions but requires optimization.

Purpose of the Study:

  • To evaluate the safety and efficacy of intermittent inflow occlusion (IIO) during robotic right donor hepatectomy (RDH).
  • To assess the impact of IIO on blood loss and perioperative outcomes in living liver donors.
  • To determine the effect of IIO on graft parameters and complications in liver transplant recipients.

Main Methods:

  • A randomized controlled trial involving 113 donors undergoing robotic RDH between April 2022 and June 2023.
  • Donors were allocated to undergo robotic RDH with (n=56) or without (n=57) IIO.
  • Primary endpoint: blood loss during surgery. Secondary endpoints: liver function tests, complications, lactate levels, and transfusion needs.

Main Results:

  • IIO significantly reduced blood loss during parenchymal transection and total blood loss in donors.
  • Recipients in the IIO arm showed significantly lower peak ALT and INR levels.
  • While not statistically significant, the IIO arm trended towards lower peak AST and fewer acute kidney injury cases in recipients.

Conclusions:

  • Intermittent inflow occlusion is a safe adjunct to robotic right donor hepatectomy.
  • IIO effectively reduces donor blood loss and improves early graft function in recipients.
  • This technique enhances the safety and outcomes of living donor liver transplantation.