Sambommatsu Yuzuru, Kumaran Vinay, Imai Daisuke, Savsani Kush, Khan Aamir A, Sharma Amit, Saeed Muhammad, Cotterell Adrian H, Levy Marlon F, Lee Seung Duk, Bruno David A
Division of Transplant Surgery, Department of Surgery, Hume- Lee Transplant Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Surg Endosc. 2025 Mar;39(3):1643-1652. doi: 10.1007/s00464-024-11469-4. Epub 2025 Jan 8.
Robotic living donor hepatectomy offers potential advantages but has been limited to high-volume centers, primarily in Asia and the Middle East. We report our experience establishing a robotic living donor right hepatectomy program in a U.S. center with low LDLT volume and no prior laparoscopic donor hepatectomy experience and analyze early outcomes.
This retrospective cohort study analyzed 37 living donor right hepatectomies (13 robotic [including one open conversion], 24 open) performed between June 2022 and February 2024.
The robotic group had longer operative times (median [range], 451 [374-568] minutes vs 368 [276-421] minutes; P < 0.001) but less blood loss (median [range], 200 [50-700] mL vs 900 [300-2500] mL; P < 0.001). One case required unplanned open conversion due to gas embolism. Two hematomas/bleeding (Clavien-Dindo grade IIIB) occurred in the robotic group, but no biliary complications. Comprehensive Complication Index, liver function tests, and hospital stays were similar between the two groups, with no 90-day graft failure/mortality.
With extensive surgical experience in both open donor hepatectomy and robotic surgery, along with meticulous preparation as a team, U.S. centers with lower LDLT volume and no laparoscopic experience can safely implement robotic living donor right hepatectomy, achieving comparable short-term outcomes to the open approach. Further research on long-term outcomes and donor quality of life is necessary.
机器人活体肝移植切除术具有潜在优势，但一直局限于主要在亚洲和中东地区的高容量中心。我们报告了在美国一个低活体肝移植量且此前无腹腔镜供体肝切除术经验的中心建立机器人活体右肝切除术项目的经验，并分析早期结果。
这项回顾性队列研究分析了2022年6月至2024年2月期间进行的37例活体供体右肝切除术（13例机器人手术[包括1例转为开放手术]，24例开放手术）。
机器人手术组手术时间更长（中位数[范围]，451[374 - 568]分钟对368[276 - 421]分钟；P < 0.001），但失血量更少（中位数[范围]，200[50 - 700]毫升对900[300 - 2500]毫升；P < 0.001）。1例因气体栓塞需要计划外转为开放手术。机器人手术组发生2例血肿/出血（Clavien-Dindo IIIB级），但无胆道并发症。两组的综合并发症指数、肝功能检查和住院时间相似，无90天移植失败/死亡率。
凭借在开放供体肝切除术和机器人手术方面的丰富手术经验，以及团队的精心准备，活体肝移植量较低且无腹腔镜经验的美国中心可以安全地实施机器人活体右肝切除术，实现与开放手术相当的短期结果。有必要对长期结果和供体生活质量进行进一步研究。
