Robotic Living Donor Hepatectomy After Previous Abdominal Surgery: Feasibility in a Carefully Selected Cohort

BackgroundPrevious abdominal surgery (PAS) complicates open and laparoscopic living donor hepatectomy through intra-abdominal adhesions. Whether a robotic-intended strategy is feasible in donors with prior operations has not been described. A single-center experience in carefully selected donors is described.MethodsAll living donor hepatectomies at a single US center (August 2019 to December 2024) were reviewed. The primary intention-to-treat cohort comprised all 31 robotic-intended cases (13 PAS, 18 No-PAS), and the 28 cases intended for fully robotic completion served as a sensitivity analysis. PAS was classified as upper or lower abdominal. Exploratory comparisons appear as effect estimates with 95% confidence intervals.ResultsRobotic-intended hepatectomy was completed in all 13 PAS donors, 5 with prior upper abdominal surgery. Neither bile leak nor liver failure developed in a PAS donor, and adhesions accounted for no conversion. Blood loss, operative time, and hospital stay did not differ significantly, yet the confidence intervals stayed wide (hospital stay difference 1 day (95% CI -0.5 to 3)), so similarity cannot be established. Ileus affected 6 of 13 PAS donors and clustered in the upper abdominal subgroup, 4 of 5 (80.0%; 95% CI 28.4 to 99.5%); across all 12 events, 11 were Clavien-Dindo grade I.DiscussionAt an experienced center, a robotic-intended strategy proved feasible across varied previous operations. The donors described here were selected, so safety or equivalence cannot be established. Lower abdominal PAS may be managed routinely, whereas upper abdominal PAS calls for selective use in experienced programs together with prospective study.