Complex donor anatomy does not influence early donor or recipient outcomes after robotic donor hepatectomy at a high-volume center

With evolving expertise, criteria to select donors for living robotic donor hepatectomy (RDH) have expanded. We studied the comparative donor and recipient outcomes in RDHs with standard grafts and complex grafts. We performed 360 right lobe RDH (RRDH) of 4296 living donor liver transplantations, with 280 having >6 months follow-up. The first 53 cases were excluded as we used a different (cut-suture) technique for hepatic duct division. The subsequent 227 RRDHs were then divided into donors with standard (group S, n = 76) and complex grafts (group C, n = 151). Three donors in each group were converted to open midline incision. In groups S and C, 1 (1.3%) and 3 (1.9%) donors developed biliary complications (P = .741). Both recipient groups had similar early and late postoperative complications. Group C recipients had a nonsignificant higher incidence of late biliary complications (3 [3.9%] vs 17 [11.2%]; odds ratio, 3.09; 95% confidence interval, 0.88-10.88; P = .067). Early (<30 days) recipient mortality was similar with 4 (6.6%) in group S and 11 (7.3%) in group C (P = .755), all sepsis-related. The outcomes were similar among donors and recipients with both standard and complex grafts. With experience, RDH can be safely offered to "all-comer" donors and has the potential to become standard of care.