Robotic Whole-graft Liver Transplant
Fabrizio Di Benedetto, Paolo Magistri, Joao Santos Coelho, Roberta Odorizzi, Raquel Mega, Barbara Catellani, Silvia Gomes da Silva, Cristiano Guidetti, Mafalda Sobral, Gian Piero Guerrini, Emanuel Vigia, Stefano Di Sandro, Hugo Pinto-MarquesBackground and Aims:
Robotic liver transplantation (RLT) represents the latest evolution in solid organ transplantation. While early reports demonstrated technical feasibility of whole-graft RLT, evidence on clinical outcomes benchmarked against established standards remains limited. This study aimed to evaluate perioperative post-transplant outcomes of whole-graft RLT and to assess whether benchmark performance can be achieved in clinical practice.
Study Design:
This retrospective multicenter cohort study included consecutive patients undergoing whole-graft RLT at 2 European centers between February 2024 and October 2025. Preoperative, perioperative, and follow-up data were retrieved from prospectively maintained databases. The primary endpoint was comparison of outcomes with LT benchmark criteria.
Results:
Forty-five patients met inclusion criteria; one was excluded due to conversion before robotic docking, yielding a final cohort of 44 patients. Hepatocellular carcinoma was the leading indication for transplantation (47.7%). Median MELD score was 11 (range 6–28), and 61.4% of recipients had clinically significant portal hypertension. Median operative time was 551 minutes, with a median warm ischemia time of 60 minutes. Conversion to open surgery occurred in 4 cases (9.1%), all of which recovered uneventfully. Median ICU and hospital stay were 2 and 10 days, respectively. Overall mortality was 2.3%. All benchmark thresholds were met except operative time, which significantly improved over time.
Conclusion:
Robotic whole-graft liver transplantation achieved benchmark-level outcomes for major perioperative and early post-transplant parameters. Despite prolonged operative duration related to procedural complexity and learning curve, RLT appears safe and reproducible when implemented in highly specialized centers with advanced robotic hepatobiliary expertise.