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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
Summary
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.
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.
