The Robotic Living Donor Liver Donation: Technical Aspects and Results

Liver transplantation (LT) is the only effective treatment for end stage liver disease. Both medical and surgical improvements allowed to reach excellent survival results for such frail patients. Nonetheless, LT is still challenged by the organ shortage, with two subsequent issues that cannot be avoided: the long waiting period, and the growing risk of dropout. Living donor liver transplantation (LDLT) has been widely accepted to overcome the shortage of deceased donors and has greatly improved thanks to tremendous technological advances. Furthermore, LDLT in many countries is the main resource of organs due to cultural and social reasons. The evolution in the last three decades of minimally invasive liver surgery (MILS) has generated heated debate regarding the appropriateness of MILS in livingrelated donor graft hepatectomy, where the priority is represented by donor safety. Technical innovations have allowed a growing recruitment of potential donors, thanks to smaller incisions and fast recovery after graft procurement. However, the technical difficulties related to MILS for major hepatectomies and the concerns about donor safety still represent a barrier for its wide adoption. The introduction of robotic system may ease such process, potentially leading to an improved safety for the donor, thanks to the overcoming of the technical difficulties of the laparoscopic approach, related to challenging ergonomics and long learning curve. The aim of this review is to summarize the technical aspects of robotic-assisted living donor hepatectomy (RLDH), with its pros and cons, showing the latest available results.