Robotic liver transplantation: University of Modena experience

Abstract

Minimally invasive techniques for solid organ transplantation are well established in kidney transplantation, whereas progress in liver transplantation has been comparatively slower. The transition to a fully minimally invasive approach for liver transplantation has required a gradual, stepwise development, significantly accelerated by the introduction of robotic technology. We herein report the largest series of whole-graft robotic liver transplantation and provide preliminary observations. This study is a retrospective, single-arm, single-center analysis of patients who underwent fully robotic total hepatectomy followed by robotic liver transplantation between January and December 2024. The primary aim was to assess short-term outcomes, including the incidence of complications, early allograft failure using the EASE score, primary nonfunction, and both graft and patient survival. Ten patients underwent robotic liver transplantation in the study period. Median age of the recipients in the study group was 63 (56-71), with a median body mass index of 26 kg/m 2 (range 21-32) and 80% of ASA score of 2. Median MELD was 8.5 (6-25), 80% of the cases were in Child class A, and 40% had a clinically significant portal hypertension. No cases of high-grade morbidity (Clavien >3a) occurred at 30 days, nor readmissions. After a median follow-up of 10.6 months, all patients are alive and in good general condition, graft survival is 100%, and liver function is optimal in all cases. The robotic approach to liver transplantation has demonstrated feasibility and promising short-term outcomes. However, extended follow-up is required to confirm these results over the long term, with the aim of confirming outcomes comparable to benchmark results of open transplantation.

Keywords: HCC; LT; MILS; robotic.