Advancing robotic surgery in pediatric liver transplantation: A case of fully robotic recipient surgery

Pediatric liver transplantation (PLT) is one of the most complex pediatric surgical procedures, and although minimally invasive recipient surgery has been reported in adults, a fully robotic PLT recipient operation has not been described. A 5-year-old boy with genetically confirmed arginosuccinate lyase deficiency presented with neonatal-onset hyperammonemia. He was offered a living donor auxiliary partial orthotopic liver transplant. His mother donated her left lateral section via a robotic approach. The recipient's operation was performed entirely robotically. The explanted liver was retrieved through a Pfannenstiel incision, which was also used for allograft introduction. The child was extubated on postoperative day (POD) 1, transitioned to normal protein-rich oral feeds from POD 3, and discharged home on POD 7. The donor recovery was uneventful, and she was discharged on POD 4. At the 6-month follow-up, the child remains well, tolerating a protein-rich diet with stable graft function. This report demonstrates the world's first robotic PLT recipient operation and the feasibility of robotically performing highly complex surgeries such as the auxiliary partial orthotopic liver transplant. We discuss how this milestone is likely to have broader implications for the future of PLT.