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. 2022 Aug;29(8):874-883.
doi: 10.1002/jhbp.1145. Epub 2022 Apr 18.

Extended criteria donors for robotic right hepatectomy: A propensity score matched analysis

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

Extended criteria donors for robotic right hepatectomy: A propensity score matched analysis

Christi Titus Varghese et al. J Hepatobiliary Pancreat Sci. 2022 Aug.

Abstract

Background: Robotic right donor hepatectomy (RDH) has been reported from experienced centers with reduced morbidity when compared to open RDH. However, outcomes in donors with large grafts/complex biliovascular anatomy are unknown.

Methods: Out of 170 robotic RDH, 100 had one or more of the following: graft weight ≥800 g, type 2/3 portal vein, >1 bile duct or hepatic artery and inferior hepatic veins >5 mm requiring reconstruction (extended criteria donors [ExRDH]), while the remaining 70 had standard anatomy (SRDH). After propensity score matching, 66 ExRDH were compared with 66 SRDH. Additionally, all robotic RDH performed were analyzed in three temporal phases (60, 60, and 50).

Results: Peak AST and ALT were higher amongst donors and recipients in the ExRDH arm compared to SRDH. Other intraoperative parameters and postoperative complications were similar between the two groups. During the last phase, donors demonstrated reduction in duration of surgery, postoperative complications, and hospital stay while recipients showed decreased blood loss and hospital stay.

Conclusion: Robotic right hepatectomy performed in donors with extended criteria have similar perioperative outcomes as standard donors. However, a significant learning curve needs to be traversed. Further studies are required before safely recommending robotic RDH for all donors.

Keywords: hepatectomy; liver transplantation; living donors; minimally invasive surgery; robot-assisted surgery.

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References

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