Robotic liver transplant: Current evidence, technical nuances, and potential pitfalls.

The introduction of robotic technology has revolutionized the field of surgery. Although transplantation initially lagged behind other subspecialities in adopting a robotic approach, interest is growing as the advantages of robotic surgery are being recognized, including enhanced 3-dimensional visualization, tremor filtration, and wristed instrumentation. While the efficacy of robotic surgery for kidney and pancreas transplant has been established, robotic liver transplantation is still in its infancy. There have been almost 100 cases of robotic liver transplantation reported in the literature from 5 transplant centers, with additional unpublished data bringing the total worldwide volume to ~200 cases. This early experience has shown it to be safe and feasible in carefully selected patients. In this manuscript, we present a comprehensive overview of the current world experience with robotic liver transplantation, including deceased donor and living donor transplants. The evolution of the procedure, indications for robotic transplantation, principles of donor and recipient selection, and the nuances of the robotic operative technique are also discussed, including annotated intraoperative photographs and links for narrated videos. Robotic liver transplantation is a complex, technically demanding operation with early positive results. However, the field is still in its infancy, and adoption of this technique should continue at high-volume centers with appropriate resources, including a dedicated, multidisciplinary robotic team.