Anesthesia for the First Fully Robotic Simultaneous Living Donor Liver Transplant in Europe

Robotic surgery is progressively redefining the scope of minimally invasive procedures, yet its role in liver transplantation remains limited. While robotic techniques have been successfully applied to living donor hepatectomy and, more recently, to deceased donor transplantation, fully robotic simultaneous living donor liver transplantation (LDLT) has not previously been reported in Europe. We present the anesthetic management of the first such case, performed in parallel operating rooms with dual robotic platforms. A 64-year-old female with hepatitis C virus-related cirrhosis and hepatocellular carcinoma underwent robotic orthotopic liver transplantation with a right lobe graft from her 38-year-old daughter. Both procedures were completed without conversion to open surgery. Careful anesthetic planning, meticulous hemodynamic control, and cross-team coordination allowed minimization of ischemia times and excellent early postoperative outcomes for both donor and recipient. This case underscores the feasibility and safety of simultaneous fully robotic LDLT and highlights the unique anesthetic challenges inherent to this novel approach.