Short-term outcomes with fully robotic vs fully open living donor liver transplantation

Findings from a retrospective comparative cohort study, evaluating short-term outcomes with fully robotic (n = 54) vs fully open (n = 453) adult-to-adult living donor liver transplantation (LDLT), were published in Annals of Surgery by Broering et al. The primary outcome measure was the Comprehensive Complication Index (CCI), a validated scoring system quantifying overall postoperative morbidity in a single continuous scale ranging from 0 (no complications) to 100 (death). 

Key data: The median CCI was lower with fully robotic vs fully open LDLT (14.8 vs 20.9; p = 0.045). After multivariable adjustment, the robotic approach was independently associated with reduced CCI (adjusted regression coefficient [β], −14.35; 95% confidence interval [CI], −23.72 to −4.98; p = 0.003). Other predictors of higher CCI were longer recipient operation duration (β, 0.05; 95% CI, 0.03–0.07 per minute; p < 0.001) and higher Model for End-Stage Liver Disease (MELD) score (β, 0.67; 95% CI, 0.31–1.02; p < 0.001). In the propensity score-matched (PSM) analysis, fully robotic vs fully open LDLT was associated with lower CCI (p = 0.025), lower major morbidity (p = 0.041), lower blood loss, fewer infections, shorter intensive care unit (ICU) and hospital stay (each p < 0.001), and superior 6-month graft and recipient survival (p = 0.020 and p = 0.040, respectively). 

Key learning: Fully robotic vs fully open LDLT was associated with lower short-term morbidity, supporting further validation through prospective, multicenter studies and randomized controlled trials.