Total Robotic Liver Transplant: The Final Frontier of Minimally Invasive Surgery.

The use of robotic surgery in transplantation is increasing, however, robotic liver transplant (RLT) remains a challenging undertaking. This is a report of the first RLT in North America and the first robotic LT using a whole graft from a deceased donor in the world. This paper describes the preparation leading to the RLT and the surgical technique of the operation. The operation was performed in a 62-year old male with hepatitis C cirrhosis and hepatocellular carcinoma (HCC) with a native MELD score of 10. The total console time for the operation was 8 hours 30 minutes, and the transplant hepatectomy took 3 hours 30 minutes. Warm ischemia time (WIT) was 77 mins. Biliary reconstruction was performed in a primary end-to-end fashion and took 19 minutes to complete. The patient had an uneventful recovery without early allograft dysfunction (EAD) or surgical complications and continues to do well after 6-months follow-up. This paper demonstrates the feasibility of this operation in highly selected patients with chronic liver disease. Additional experience is required to fully understand the role of RLT in the future of transplant surgery. Narrated video is available at https://youtu.be/TkjDwLryd3I.