Robotic Liver Transplantation Comes of Age: A Narrative Review of Technique and Early Outcomes

Abstract

To review the evolving role of robotic recipient liver transplantation, including its emergence from experience in robotic hepatobiliary surgery and living-donor hepatectomy, global adoption, operative techniques, patient and graft selection, and anesthetic and logistical considerations. Robotic liver transplantation has progressed from isolated reports to increasingly standardized procedures across multiple centers using living- and deceased-donor grafts. Early studies demonstrate favorable perioperative outcomes and short-term patient and graft survival in highly selected recipients with pooled evidence of 3 studies and 70 patients, 77% of whom come from a single center. Machine perfusion has emerged as an important adjunct in deceased-donor transplantation, mitigating concerns related to longer ischemia times. Evidence remains limited by small cohorts, selection bias, and short follow-up. Robotic liver transplantation is a feasible and promising extension of minimally invasive hepatobiliary surgery and transplantation but remains early in its evolution. Multicenter registries, long-term outcomes, standardized training, broader selection criteria, and cost-effectiveness analyses are needed to define its role.