Introduction

Robotic left lateral sectionectomy (LLS) has been reported as safe with comparable results to laparoscopic LLS for living donation (LD) for pediatric recipients. We aim to examine donor and recipient outcomes as we transition our LD program from laparoscopic to robotic LLS.  

Method

A retrospective chart review was conducted for LDs undergoing robotic LLS from 2023-2024 and laparoscopic LLS from 2018-2023. Demographic data, operative details, and outcomes were compared. Surgeons performing both laparoscopic and robotic operations have extensive experience in their respective techniques.

Results

Eleven robotic and 30 laparoscopic LLS were performed. Donor and recipient characteristics were found to be similar between the groups (Table 1).  The median operative time was 273 minutes for laparoscopy vs. 265 minutes for robotic (p=0.888). Robotic LLS was associated with less blood loss than laparoscopic (median 27.5ml vs 100ml, p<0.001) and no transfusions were required in the robotic group. There were no conversions to open in either group. 

Length of stay was similar (median=4 days). Robotic technique was associated with earlier initiation of solid food. There were five Clavien-Dindo III complications in the laparoscopic group (20.8%) and none in the robotic group (Table 1).  Recipient biliary complications were similar between both.

Conclusion

Robotic LLS may convey incrementally improved outcomes versus laparoscopy. To the best of our knowledge, we report outcomes of the first US experience of robotic LLS LD hepatectomy. Establishing a robotic LD program can be successful in high-volume centers with expertise in minimally invasive techniques in hepatobiliary surgery and living donation.