First Total Robotic Living Donor Liver Transplantation in North America

ABSTRACT Background The application of robotic technology to liver transplantation is challenging due to the procedure's complexity. Methods We present the first robotic living donor liver transplantation performed in North America, detailing our stepwise implementation and key technical aspects. Our programme's gradual adoption of robotic techniques culminated in this procedure for a 50‐year‐old woman with autoimmune hepatitis (MELD 18), who received a graft from a 53‐year‐old male donor. Results Total operative time was 683 min, with a warm ischaemia time of 51 min and estimated blood loss of 50 mL. The hepatic vein, portal vein, hepatic artery, and bile duct anastomoses took 17, 13, 42, and 23 min, respectively. The postoperative course was uneventful, with discharge on postoperative day 17. The patient remained well at 4 months. Conclusions This case demonstrates the feasibility of robotic living donor liver transplantation, though prolonged warm ischaemia time remains a limitation.