Anesthesiological and Perioperative Aspects of Fully Robotic Versus Open Liver Transplantation: A Matched Case-control Study

Abstract Background Robotic liver transplantation (LT) is a recent advancement in minimally invasive surgery; however, perioperative and anaesthetic management have not yet been described in detail. This study aimed to characterise the anaesthetic course of fully robotic LT and compare the perioperative outcomes with those of propensity score–matched open LT. Methods We conducted an observational, retrospective, single-centre study at Modena University Hospital. Fully robotic LTs were compared with matched open LTs. Matching was performed in a 1:1 ratio according to age, sex, BMI, year of transplantation, indication, presence of hepatocellular carcinoma, and MELD score. Results Eighteen robotic and 457 open LTs were initially identified; after matching, 11 robotic and 11 open cases were included in the study. In the robotic group, the operative time was longer (p < 0,05) and associated (p < 0,05) with higher lactate levels, greater norepinephrine requirement, and larger blood loss, requiring a larger use of blood components compared to standard open surgery. Postoperatively, extubation timing, cardiovascular, respiratory, and liver function recovery, and renal complications were comparable between the groups. Pain control required less opioids (p < 0,05) and ICU (p > 0,05) and hospital stay (p < 0,05) were lower in robotic than in open surgery. Conclusions Fully robotic LT is associated with longer operative times, greater blood loss, and increased haemodynamic demands. Despite these challenges, postoperative recovery, particularly hospital stay, appears to be favourable. Larger multicentre studies are needed to validate these findings and refine the anaesthetic strategies.