Rapid-Fire Presentation

Robotic donor hepatectomy is associated with superior long-term outcomes compared to laparoscopic or open: A single-center prospective registry study of 2,102 cases

Presenter

Saleh Alabbad (SA)

Chairman · Abdominal Transplant and hepatobiliary center · King Faisal Specialist Hospital & Research Center · Riyadh

Profile

Authors

Dieter Broering^1,2, Luigi Rescigno¹, Kotsifa Evgenia¹, Mariya Ekimova¹, Yasser Elsheikh¹, Yasir Alnemary¹, Saleh Alabbad¹, Bandar Aljudaibi¹, Saad Alghamdi¹, Saleh Alqahtani¹, Markus Boehnert¹, Massimo Malago¹, Yao-Ming Wu³, Roberto Troisi⁴, Dimitri Raptis^1,2

Affiliations

¹ King Faisal Specialist Hospital and Research Centre

² Al Faisal University

³ National Taiwan University Hospital

⁴ Division of HPB Minimally Invasive and Robotic Surgery

Abstract

Introduction: Robotic donor hepatectomy may reduce perioperative morbidity however it is unclear whether this benefit persists in the long term.
Methods: This study analyzed a single-center, prospectively maintained living donor registry (2011–2024) including 2,102 consecutive adult donors who underwent open (n=646), laparoscopic (n=165), or robotic (n=1,291) donor hepatectomy. Complications were analyzed over time using the Comprehensive Complication Index (CCI^®), with cumulative rates for any (Grade ≥1) and major (Grade ≥3a) complications estimated by Kaplan-Meier analysis and compared using multivariable Cox regression.
Results: Long-term complication rates at 5 years were 25.0% for open, 20.1% for laparoscopic, and 8.6% for robotic (p<0.001). After adjustment for age, sex, body mass index, graft type, and donor future liver remnant, robotic donor hepatectomy remained associated with a lower risk of any complication (HR 0.23, 95% CI 0.17-0.30, p<0.001) and of major complications (HR 0.43, 95% CI 0.24–0.78; p=0.005) versus open. The laparoscopic approach did not differ from open for complications of any severity (p=0.960).
Conclusion: In this large cohort with long-term follow-up, robotic donor hepatectomy was associated with persistent lower morbidity compared with laparoscopic and open approaches, supporting its preferential use in experienced centers and indicating the need for broader adoption.