Fully robotic dual-graft living donor liver transplantation: a case report

Robotic surgery was recently introduced as a promising tool in liver transplantation, offering improved precision, ergonomics, and magnified 3D visualization. To our knowledge, this article reports the first fully robotic dual-graft living donor liver transplantation (LDLT) in the world, a surgical procedure not yet widely adopted due to its complexity, even when performed in open surgery and mastered in very few centers worldwide. A 62-year-old woman with end-stage liver disease due to hepatic schistosomiasis (MELD 23) underwent fully robotic dual-graft LDLT. Two related donors provided left-lobe grafts, both retrieved through a pure robotic donor hepatectomy approach, enabling adequate graft volume when a single donor graft was not feasible. The recipient operation duration was 12 hours, with warm ischemia time of 46 minutes for the first graft and 36 minutes for the second one. The total implanted graft weight was 524 g with an actual combined graft-to-recipient weight ratio of 0.74%. The recipient experienced no early allograft dysfunction or surgical complications and was discharged with excellent graft function. This case shows the feasibility of fully robotic dual-graft LDLT in carefully selected patients when a single donor graft is insufficient and no other suitable donor is available.