Robotic Versus Open Right Lobe Donor Hepatectomy for Adult Living Donor Liver Transplantation: A Propensity Score-Matched Analysis.

Broering, Dieter; Elsheikh, Yasser; Alnemary, Yasir; Zidan, Ahmed; Elsarawy, Ahmed; Saleh, Yahia; Alabbad, Saleh; Sturdevant, Mark; Wu, Yao-Ming; Troisi, Roberto

Robotic right lobe donor hepatectomy (RRLDH) is rarely performed, and data concerning its safety and efficacy are lacking. Here we compare our series of RRLDHs with a similar cohort undergoing open right lobe donor hepatectomy (ORLDH) with a propensity score-matched (PSM) analysis. Among 263 consecutive adult patients undergoing right lobe living donor hepatectomy from January 2015 until July 2019, 35 RRLDHs were matched to 70 ORLDHs. A 1:2 PSM analysis was performed to make the groups comparable for donor gender, age, and body mass index (BMI) and recipient gender, age, BMI, Model for End-Stage Liver Disease (MELD) score, and indication for transplant. Operative time was longer in RRLDHs compared to ORLDHs (504 ± 73.5 vs. 331 ± 65.1 minutes; P < 0.001) but significantly decreased with the number of cases (P < 0.001). No conversions occurred. The warm ischemia time was longer and blood loss significantly less in RRLDHs (P = 0.001 and 0.003, respectively). Overall donor complications were similar: 2 (5.7%) in RRLDHs versus 12 (17.1%) in ORLDHs (P = 0.13). Biliary leak occurred in 1 (3%) robotic case and 2 (3%) cases with the conventional approach. Donors undergoing robotic surgery required less patient-controlled analgesia (PCA) and had a shorter hospital stay compared to the open surgery group (P = 0.001 and P < 0.001, respectively). No significant differences in graft anatomical data and recipient outcomes were recorded. Conclusion: RRLDH is feasible, safe, and reproducible, with significantly decreased blood loss and a shorter hospital stay compared to the open procedure. The first 35 robotic cases showed a substantial reduction in operative time, reflecting a rapid shortening of the learning curve.