Robotic liver transplantation surgery: A comprehensive review of minimally invasive techniques, surgical and educational advancements

Table 1 Current robotic surgical approaches for donor and recipient hepatectomy

	Surgical approaches
Donor hepatectomy[3-7]	Minimally invasive approaches are increasingly applied to right lobe, left lateral lobe, and adult or paediatric grafts
	Robotic assistance allows improved control of parenchymal transection and may reduce donor morbidity
	Patient positioning: Trendelenburg position to enhance upper abdominal exposure
	Port placement: Five ports (one 12-mm camera port and four 8-mm robotic working ports) arranged in a semicircular or fan-shaped configuration for optimal triangulation
	Liver mobilization: Atraumatic robotic manipulation enables precise division of hepatic ligaments
	Intraoperative imaging: Robotic intraoperative ultrasound facilitates detailed vascular mapping
	Vessel and bile duct dissection: High precision achieved using robotic bipolar forceps and energy devices, minimizing thermal injury
	Parenchymal transection: Performed using ultrasound and bipolar energy devices, frequently guided by indocyanine green fluorescence to visualize bile ducts and vascular structures
Recipient hepatectomy[3-7]	Patient positioning: Supine with reverse Trendelenburg tilt to improve venous return and exposure
	Port placement: Similar to donor configuration, adjusted for patient anatomy and prior surgical history
	Native liver removal: Robotic mobilization with precise control of the hepatic artery, portal vein, and bile duct, minimizing blood loss
	IVC: Preservation of the retrohepatic IVC using the piggyback technique
Graft implantation[3-7]	Caval anastomosis: Performed robotically in side-to-side or end-to-end fashion
	Portal vein anastomosis: Completed under robotic visualization with fine sutures
	Hepatic artery anastomosis: Performed robotically using microsurgical techniques or via mini-laparotomy with a surgical microscope
	Biliary reconstruction: End-to-end anastomosis preferred; Roux-en-Y hepatojejunostomy used when necessary. Robotic suturing enhances precision and may reduce bile leak rates
Operative outcomes[3-7]	Robotic liver transplantation offers stable instrumentation and tremor reduction, facilitating high-quality vascular and biliary anastomoses
	Operative time is influenced by team experience, anatomical variability, and graft complexity
	Reported hospital length of stay is approximately 7.5 days

IVC: Inferior vena cava.