In a recent review article published in the Journal of Laparoscopic, Endoscopic and Robotic Surgery, researchers investigated the current status and future potential of robotic surgery in liver transplantation. The researchers reviewed the existing literature on robotic liver resection in living donors, robotic liver resection, and graft transfer in liver recipients, noting both advantages and limitations. They also addressed technical challenges and potential solutions to enhance robotic surgery in this field.
Study: Robotic surgery in living donor liver transplant recipients and transplant patients. Image credit: Gorodenkoff/Shutterstock.com
background
Robotic surgery is a minimally invasive technique that uses advanced robotic systems to perform complex surgeries with high precision and low risk. It is increasingly being used in liver transplants, benefiting both donors and recipients. Liver transplantation is an important treatment for end-stage liver disease and liver cancer.
The shortage of deceased donor organs and high mortality rates on the waiting list have led to the emergence of living donor liver transplantation (LDLT). LDLT involves a complex procedure in which a healthy person donates part of their liver, and a portion of the liver is removed from the donor and transplanted into the recipient. Traditionally, this is done in an open surgery, involving large incisions and a long recovery period. Minimally invasive techniques such as laparoscopy and robotics have been introduced to reduce surgical trauma and improve outcomes.
Laparoscopy involves inserting a camera and instruments through small incisions in the abdomen, while robotic surgery uses a computer-controlled system that mimics the surgeon’s hand movements. Both techniques provide better visibility, less blood loss, less pain, faster recovery, and better cosmetic results. Additionally, robotic surgery provides improved dexterity, stability, and ergonomics, facilitating difficult tasks such as parenchymal transfers, vascular anastomoses, and bile duct reconstruction.
About the Research
In this review, we aimed to summarize the current literature and experience regarding robotic surgery in liver transplantation for both living donors and recipients.We searched PubMed, Scopus, and Web of Science for articles published from 2012 to 2024 using keywords such as “liver transplantation,” “robotic surgery,” “robotic hepatectomy,” “robotic hepatectomy,” and “robotic liver transplantation.”
Included studies included those that discussed the feasibility, safety, outcomes, limitations, learning curve, and future perspectives of robotic surgery in liver transplantation. Studies lacking detailed information on surgical technique, outcomes, complications, or including hybrid or manually assisted approaches were excluded.
Using these criteria, the researchers identified 16 articles covering 1,027 living-donor robotic liver resections and seven recipient robotic liver transplants. They analyzed data on surgical technique, operative time, blood loss, conversion rate, complications, length of hospital stay, and graft function. They also discussed technical challenges, learning curves, and cost-effectiveness.
research result
Results showed that robotic surgery in living donors is feasible and safe, with outcomes comparable or superior to open or laparoscopic surgery. Robotic surgery was used primarily for the most demanding right hepatectomies, but also for left hepatectomies and left lateral resections. Robotic surgery reduced blood loss, postoperative pain, and hospital stay, while preserving graft quality and function. The main disadvantages were the long operative time and high costs, but with experience and technological advances these may be reduced.
The authors found that robotic surgery, although feasible and promising for recipients, is still in its infancy and there are only a few reported cases. Robotic surgery was used for both liver resection and graft implantation, either as a pure or hybrid technique. Robotic surgery improves the accuracy and ease of vascular and biliary anastomosis, which are crucial for graft survival. However, challenges included the size and weight of the robotic system, the lack of haptic feedback, and the need for specialized instruments. The long-term effects of robotic surgery on recipients remained unknown and required further study.
application
Robotic surgery has the potential to improve liver transplant outcomes for both donors and recipients. Robotic surgery can expand the donor pool by attracting more donors who prefer a minimally invasive approach and by allowing the use of complex and marginal grafts. It can also improve recipient survival and quality of life by reducing surgical trauma, complications, and immunosuppression. In addition, it can aid in the training and education of transplant surgeons by providing an ergonomic environment and allowing the use of dual consoles for monitoring.
Conclusion
This review concludes that robotic surgery may be a promising tool to provide greater precision and a less invasive option for liver transplantation, but technical limitations, including the size of the robotic system, lack of haptic feedback, high cost, and the need for extensive training, have prevented widespread adoption.
Therefore, continued technological advances and in-depth clinical studies can help overcome these challenges and fully integrate robotic surgery into liver transplantation. The development of new robotic platforms and devices, such as haptic feedback systems and specialized instruments, can also help address these challenges and optimize the role of robotic surgery in liver transplantation.
Journal Reference
Semash, K. Robotic Surgery in Living Donors and Liver Transplant Patients. Laparoscopic, Endoscopic and Robotic Surgery, 2024. DOI: 10.1016/j.lers.2024.06.003, https://www.sciencedirect.com/science/article/pii/S2468900924000458
