Robotic surgery in liver transplantation: Current status and perspectives from living and deceased donor settings

Robotic surgery has progressively expanded its role in hepatopancreatobiliary surgery, and its application to liver transplantation represents one of the most advanced developments in minimally invasive surgery. However, the clinical value, indications, and limitations of robotic approaches in liver transplantation remain incompletely defined.

This narrative and critical review summarized the available literature on robotic surgery in liver transplantation, focusing on three distinct settings: robotic living donor hepatectomy (RLDH), robotic living donor liver transplantation (RLDLT), and robotic deceased donor liver transplantation (RDDLT). Published clinical series, observational studies, and selected expert guidance were analyzed to evaluate technical feasibility, patient selection, perioperative outcomes, and learning curve considerations.

RLDH has been shown to be feasible and safe in carefully selected donors when performed in high-volume centers, with donor outcomes comparable to laparoscopic and open approaches. RLDLT in recipients represents a further level of technical complexity; limited single-center experiences suggest favorable short-term postoperative outcomes without compromising early graft function, although these results are highly dependent on patient selection and institutional expertise. RDDLT remains confined to a small number of pioneering centers, with evidence limited to small case series demonstrating technical feasibility and encouraging short-term outcomes.

Robotic surgery in liver transplantation is a promising and evolving field. Current evidence supports its use in highly selected patients and specialized centers, while broader adoption will require further validation and standardization.