Current evidence and experience with robotic donor hepatectomy for living-donor liver transplantation

Robotic donor hepatectomy (RDH) has emerged as an important advancement in the field of living donor liver transplantation, aimed at improving donor safety, surgical precision, and acceptance of the donation process. This article evaluates the current evidence regarding RDH, including technical developments, learning curve, and comparative outcomes with laparoscopic and open approaches. A literature search was conducted according to PRISMA guidelines on PubMed and Embase using the term “robotic donor hepatectomy.” Sixteen studies were included, consisting of technical reports, learning-curve analyses, and comparative series. Recent reports have shown that RDH can be safely applied even in donors with complex anatomy, with a safety profile comparable to open and laparoscopic approaches but with a significant reduction in postoperative morbidity. Technical tools like indocyanine green fluorescence and enhanced three-dimensional visualization enhance bile duct identification and facilitate vascular dissection. The learning curve for RDH was reported to be relatively short for surgeons with LDLT and advanced hepatobiliary surgery profiency, ranging between 9 and 17 cases to achieve proficiency, though institutional and team experience remain relevant. Comparative analyses have shown lower morbidity in both donors and recipients following RDH, even when the recipient procedure was performed via an open approach, despite longer warm ischemia and operative times. Overall, RDH is a safe, potentially reproducible, and minimally invasive alternative to traditional donor hepatectomy. The evidence supports its growing adoption in centers with established expertise in advanced robotic hepatobiliary surgery, offering a balance among donor safety, technical superiority, and enhanced recovery.