A minimally-invasive fully robotic right liver lobe resection and procurement for adult-to-adult living donor liver transplantation was performed at the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT) in Palermo. The procedure was performed using the da Vinci® robotic surgical system, the only one of its kind currently available on the market. This is the first case in the world performed entirely and exclusively with the robotic technique. In the past, some living donor liver transplants had been performed in the U.S. using the robot, but aided by the surgeon who inserted his hand through an abdominal incision to perform the surgery with the robot. The case carried out at ISMETT was exceptional because it was entirely performed with the robotic minimally-invasive technique; only the robot’s arms operated inside the donor’s abdomen.

Thanks to the robot, only 5 keyhole incisions and a 9-cm incision were required to perform the liver resection. The robot was used in the donor for the resection and procurement of the right liver lobe. This was transplanted to the donor’s 44-year-old brother, a liver cirrhosis patient on ISMETT’s liver transplant waiting list. The surgery lasted about ten hours. Post-operative recovery was uneventful for both brothers and presented no major complications. The donor was discharged 9 days after the surgery and returned to his normal life. The recipient was discharged after 9 days and today he is well and has returned home.

Robotic surgery combines the benefits of traditional minimally-invasive surgery, already widely used in general surgery and in organ procurement (e.g. kidneys) from living donors, with the accuracy and safety of the robotic system. Thanks to its articulated tools, this system can perform movements that would be impossible for the surgeon’s hand. This not only allows to perform complex procedures (such as procurement of a portion of liver for transplant) using a totally safe minimally-invasive technique, but also involves a shorter post-operative recovery time for the donor and a lower risk of intra-operative hemorrhage, reduced pain and a quicker return to normal life.
The procedure was performed on a 46-year-old man who decided to donate part of his liver to his brother, diagnosed with liver cirrhosis. The procedure was performed in March but news was released today a few days after the recipient's discharge. A surgical team of a dozen doctors and nurses was involved in the operating room. The team was led by ISMETT Director Prof. Bruno Gridelli and by Dr. Marco Spada, Chief of ISMETT’s Abdominal and Transplantation Surgery Unit. The procedure was performed in collaboration with a team from Cisanello University Hospital of Pisa led by Prof. Ugo Boggi, Chief of the Division of General and Transplant Surgery in Uremic Patients.

The da Vinci® System consists of a patient-side cart with four interactive robotic arms that position and maneuver miniaturized instruments introduced in the donor’s abdominal cavity through keyhole incisions. A console allows the surgeon to have an enlarged 3D high-definition view of the abdominal cavity. This refined and intuitive technology translates the movements of the surgeon's hands and fingers into precise movements of the surgical instruments inside the patient. This allows to drastically reduce the surgical trauma associated with complex surgery.
The use of new technologies in transplant surgery is extremely important since reducing trauma for patients may encourage living organ donations and increase the number of transplants. This breakthrough event at ISMETT was a perfect example of a successful collaboration between transplant centers from different Italian regions, and of how such collaborations can encourage progress in the field of transplant surgery.