Broering Dieter C, Elsheikh Yasser, Alnemary Yasir, Mahmood Arshad, Majeed Amer, Marcos Amadeo, Alabbad Saleh, Boehnert Markus U, Malago Massimo, Raptis Dimitri A
Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Ann Surg. 2025 Jun 20. doi: 10.1097/SLA.0000000000006807.
To compare short-term outcomes between open and fully robotic adult recipient living donor liver transplantation (LDLT).
LDLT remains a challenging procedure, traditionally performed using the open approach. Recent advancements in robotic surgery offer potential benefits, including enhanced precision, and reduced invasiveness.
This study compared two adult-to-adult recipient LDLT groups: 453 open cases and 54 fully robotic cases. Multivariable linear regression analysis was conducted to identify independent predictors of morbidity, as captured by the Comprehensive Complication Index® (CCI®).
Robotic recipient liver transplantation was associated with lower median blood loss (650 vs. 2,000 ml, P<0.001), shorter ICU (3 vs. 5 d, P<0.001) and hospital stay (14 vs. 20 d, P=0.030), and fewer infection rates (9.3% vs. 42.8%, P<0.001), when compared to open. The CCI® was significantly lower in the robotic group (15.0 vs. 20.9, P=0.045). Graft survival at 6 months was 98.1% in the robotic vs. 91.8% in the open group (P=0.080), while recipient survival was superior in the robotic group (100% vs. 91.8%, P=0.040).
Fully robotic recipient LDLT is feasible and safe, with potential benefits including reduced morbidity, faster recovery, and shorter hospital stay. These findings support broader adoption of robotic techniques in liver transplantation, pending further cost-effectiveness studies and randomized controlled trials.
比较开放手术与全机器人辅助成人活体肝移植受者的短期结局。
活体肝移植仍是一项具有挑战性的手术，传统上采用开放手术方式。机器人手术的最新进展带来了潜在益处，包括更高的精准度和更低的侵袭性。
本研究比较了两个成人对成人受者的活体肝移植组：453例开放手术病例和54例全机器人辅助手术病例。采用多变量线性回归分析来确定由综合并发症指数（CCI®）所反映的发病率的独立预测因素。
与开放手术相比，机器人辅助肝移植受者术中失血量中位数更低（650 vs. 2000 ml，P<0.001），重症监护病房（ICU）住院时间更短（3 vs. 5天，P<0.001），住院时间更短（14 vs. 20天，P=0.030），感染率更低（9.3% vs. 42.8%，P<0.001）。机器人手术组的CCI®显著更低（15.0 vs. 20.9，P=0.045）。机器人手术组6个月时的移植物存活率为98.1%，开放手术组为91.8%（P=0.080），而机器人手术组的受者存活率更高（100% vs. 91.8%，P=0.040）。
全机器人辅助肝移植受者手术可行且安全，潜在益处包括发病率降低、恢复更快和住院时间缩短。这些发现支持在肝移植中更广泛地采用机器人技术，但有待进一步的成本效益研究和随机对照试验。
