Robotic liver transplantation: University of modena experience

Introduction: Minimally invasive techniques for solid organ transplantation are well established in kidney transplantation, whereas progress in liver transplantation (LT) has been comparatively slower. The transition to a fully minimally invasive approach for LT has required a gradual, stepwise development, significantly accelerated by the introduction of robotic technology. We herein report the largest series of whole graft robotic liver transplantation and provide preliminary observations. Methods: This study is a retrospective, single-arm, single-center analysis of patients who underwent fully robotic total hepatectomy followed by robotic liver transplantation (RLT) between January and December 2024. The primary aim was to assess short-term outcomes, including the incidence of complications, early allograft failure (EAF) using the EASE score, primary non-function (PNF), and both graft and patient survival. Results: Ten patients underwent RLT in the study period. Median age of the recipients in the study group was 63 (56-71), with a median BMI of 26 Kg/m2 (range 21-32) and 80% of ASA score of 2. Median MELD was 8.5 (6-25), 80% of the cases were in Child class A, 40% had a clinically significant portal hypertension. No cases of high-grade morbidity (Clavien >3a) occurred at 30 days, nor readmissions. After a median follow-up of 10.6 months all patients are alive and in good general conditions, graft survival is 100% and liver function is optimal in all cases. Conclusions: The robotic approach to liver transplantation has demonstrated feasibility and promising short-term outcomes. However, extended follow-up is required to confirm these results over the long term with the aim to confirm outcomes comparable to benchmark results of open transplantation.