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. 2022 Jan-Mar;18(1):157-160.
doi: 10.4103/jmas.JMAS_35_21.

Technique of robotic right donor hepatectomy

Biju Chandran  1 , Christi Titus Varghese  1 , Dinesh Balakrishnan  1 , Krishnanunni Nair  1 , Shweta Mallick  1 , Johns Shaji Mathew  1 , Binoj Sivasankara Pillai Thankamony Amma  1 , Ramachandran Narayana Menon  1 , Unnikrishnan Gopalakrishnan  1 , Othiyil Vayoth Sudheer  1 , S Sudhindran  1
Affiliations

Technique of robotic right donor hepatectomy

Biju Chandran et al. J Minim Access Surg. 2022 Jan-Mar.

Abstract

Background: Although minimally invasive right donor hepatectomy (RDH) has been reported, this innovation is yet to be widely accepted by transplant community. Bleeding during transection, division of right hepatic duct (RHD), suturing of donor duct as well as retrieval with minimal warm ischemia are the primary concerns of most donor surgeons. We describe our simplified technique of robotic RDH evolved over 144 cases.

Patients and methods: Right lobe mobilization is performed in a clockwise manner from right triangular ligament over inferior vena cavae up to hepatocaval ligament. Transection is initiated using a combination of bipolar diathermy and monopolar shears controlled by console surgeon working in tandem with lap CUSA operated by assistant surgeon. With the guidance of indocyanine green cholangiography, RHD is divided with robotic endowrist scissors (Potts), and remnant duct is sutured with 6-0 PDS. Final posterior liver transection is completed caudocranial without hanging manoeuvre. Right lobe with intact vascular pedicle is placed in a bag, vascular structures then divided, and retrieved through Pfannenstiel incision.

Conclusion: Our technique may be easy to adapt with the available robotic instruments. Further innovation of robotic platform with liver friendly devices could make robotic RDH the standard of care in future.

Keywords: Live donor; liver transplantation; minimally invasive surgery; right hepatectomy; robotic surgery; technique.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Port position
Figure 2
Figure 2
Right lobe mobilisation
Figure 3
Figure 3
Hilar dissection
Figure 4
Figure 4
Caudate division
Figure 5
Figure 5
Roboto-clasia
Figure 6
Figure 6
Indocyanine green view of hilum
Figure 7
Figure 7
Looped segment VIII vein
Figure 8
Figure 8
Right hepatic vein stapling
See this image and copyright information in PMC

References

    1. Navarro JG, Rho SY, Choi GH. Robotic liver resection. Ann Robot Innov Surg. 2020;1:15–32.
    1. Broering DC, Elsheikh Y, Alnemary Y, Zidan A, Elsarawy A, Saleh Y, et al. Robotic versus open right lobe donor hepatectomy for adult living donor liver transplantation: A propensity score-matched analysis. Liver Transpl. 2020;26:1455–64. - PubMed
    1. Varghese CT, Bharathan VK, Gopalakrishnan U, Balakrishnan D, Menon RN, Sudheer OV, et al. Randomized trial on extended versus modified right lobe grafts in living donor liver transplantation. Liver Transpl. 2018;24:888–96. - PubMed
    1. Choi SH, Choi GH, Han DH, Choi JS. Laparoscopic liver resection using a rubber band retraction technique: Usefulness and perioperative outcome in 100 consecutive cases. Surg Endosc. 2015;29:387–97. - PubMed
    1. Chen PD, Wu CY, Hu RH, Ho CM, Lee PH, Lai HS, et al. Robotic liver donor right hepatectomy: A pure, minimally invasive approach. Liver Transpl. 2016;22:1509–18. - PubMed