First Series of Purely Robotic Liver Transplantation in Children

Fully robotic liver transplantation, as defined by pure robotic donor hepatectomy as well as pure robotic liver transplantation, remains underexploited in pediatric recipients because of limited abdominal space and the absence of pediatric-specific robotic systems. To our knowledge, this study reports the first series of robotic liver transplantation in pediatric recipients. Consecutive pediatric recipients that underwent robotic liver transplantation between 30 May and 9 February 2026 using the DaVinci®Xi Surgical System were included. Seven pediatric robotic liver transplants were performed, including 6 (85.7%) partial graft implantations fully robotic and 1 (14.3%) whole liver implant via domino transplantation, retrieved with the open approach from a separate pediatric donor and implanted robotically. Median recipient age and body mass index were 12.5 years and 17 kg/m², respectively. Median operation duration was 458min, median warm ischemia time 46min, and median blood loss 500 ml. Major postoperative complications (Grade≥3a) occurred in three recipients. No graft loss or mortality occurred during follow-up with a median of 15.8 months. Purely robotic liver transplantation in pediatric recipients is feasible in centers with extensive robotic liver surgery and pediatric transplantation experience. Further studies are required to evaluate long-term outcomes and define the role of robotic transplantation in pediatric patients.