Laparoscopic donor and recipient hepatectomy followed by robot‐assisted liver graft implantation in living donor liver transplantation

Minimally invasive surgery has been introduced for liver transplantations. Although laparoscopic or robot‐assisted living donor hepatectomy is being used, minimally invasive surgery is rarely performed in recipients during liver transplantation. A 63‐year‐old patient (body mass index: 21.9 kg/m2) with primary biliary cirrhosis underwent total laparoscopic explant hepatectomy, followed by robot‐assisted liver engraftment using advanced technological innovations. The total operation time for the recipient was 12 h 20 min, including laparoscopic explant hepatectomy (140 min) and robot‐assisted engraftment (220 min). Achieving hepatic and portal vein anastomoses consumed 35 and 28 min, respectively. The hepatic artery anastomosis and bile duct reconstruction took 83 and 66 min, respectively. The estimated blood loss was 3600 ml. The warm and cold ischemic times were 87 and 220 min, respectively. The patient received 10 units each of red blood cells and fresh frozen plasma during the surgery and recovered from early allograft dysfunction after liver transplantation. This case study suggests that laparoscopic explant hepatectomy followed by robot‐assisted engraftment is feasible in selected recipients only. We obtained informed consent for this innovative procedure from the patient and from her living donor. Robot‐assisted engraftment is the stepping stone of the full‐scale application of robotic surgery to recipients in liver transplantation.