IRIS UniCatt

BACKGROUND: Living donor liver transplantation is a critical solution to the global organ shortage. Comparisons of donor short-term outcomes according to the surgical approach are limited to a few single-center retrospective studies. This study aimed to evaluate the short-term outcomes of open, laparoscopic, and robotic surgical approaches to living donor hepatectomy using data from the prospective International Living Donor Liver Transplantation Registry (LDLTregistry.org). METHODS: Data from 2600 living donors undergoing hepatectomy were prospectively collected from September 2023 to February 2025. Donors were grouped into open (1726; 66.4%), laparoscopic (242; 9.3%), and robotic (632; 24.3%) approaches. RESULTS: The mean donor age was 33 (SD 9.4) y, with 45% women and a mean body mass index of 24.7 kg/m² (SD 6.5). Conversion rates were 15.3% for laparoscopic and 5.1% for robotic approaches (odds ratio, 0.30; 95% confidence interval, 0.17-0.50; P  < 0.001). Robotic hepatectomy was associated with the lowest intraoperative blood loss (70 mL; interquartile range, 50-100), lowest pain scores on postoperative day 1 (visual analog scale, 2.3; SD 1.9), and shortest hospital stay (4 d; interquartile range, 3-5). Robotic hepatectomy was associated with the lowest overall (grade ≥1; 4.6%) and major (grade ≥3a; 0.3%) complication rates compared with laparoscopic (16.5% overall, 3.7% major) and open (10.4% overall, 1.9% major) approaches ( P  < 0.001). CONCLUSIONS: This is the first global study to show evidence that robotic living donor hepatectomy offers superior short-term outcomes compared with laparoscopic and open approaches. Although open surgery remains the most common approach, robotic techniques show promise for improving donor safety and recovery.

Rela, M., Pomfret, E., Egawa, H., Bhangui, P., Raptis, D. A., Berenguer, M., Spiro, M., Rela, M., Chaudhary, A., Humar, A., Shaked, A., Chan, A., Kow, A., Chieh, W., Jafarian, A., Singh Soin, A., Davidson, B., Goh, B., Chen, C., Miller, C., Chi Wang, C., Toso, C., Azoulay, D., Cherqui, D., Kruger, D., Balci, D., Manas, D., Bezinover, D., Jin Joo, D., Di Benedetto, F., Testa, G., Kabacam, G., Sapisochin, G., Eilers, H., Ozden, I., Findlay, J. Y., Pomposelli, J., Lerut, J., Dong, J., Liu, J., Fung, J., Roberts, J. P., Kim, J., He, K., Olthoff, K., Hasegawa, K., Hashimoto, K., Man, K., Watt, K., Patel, M. S., Cattral, M., Ghobrial, M., Malago, M., Kasahara, M., Ascher, N., Selzner-Malekkiani, N., Goldaracena, N., Bhangui, P., Jalan, R., Kamel, R., Adam, R., Troisi, R. I., Alqahtani, S. A., Nagral, S., Zheng, S., Nadalin, S., Asthana, S., Mccluskey, S. A., Gupta, S., Eguchi, S., Pan, T., Sakai, T., Cho-Lam Wong, T., Mas, V. R., Vohra, V., Vij, V., Polak, W., Andraus, W., Tokat, Y., Soejima, Y., Mayr, A., Dominguez, B., Muller, E., Rando, K., Mueller, T., Mayr, A., Raptis, D. A., Hidalgo Salinas, C., Spiro, M., Syn, N., Tinguely, P., Raptis, D. A., Prosperi, E., Spiro, M., Pomfret, E. A., Broering, D. C., Kirchner, V. A., De Martin, E., Shingina, A., Rammohan, A., Vinaixa, C., Borja-Cacho, D., Nasralla, D., Patel, D., Ann Wilson, E., Prosperi, E., Alconchel, F., Roll, G., Abdul, H., Liu, J., Shaji Mathew, J., Bzeizi, K., Patel, M. S., Izzy, M., Boehnert, M. U., De Santibanes, M., Zayed, N., Keskin, O., Andacoglu, O., Abreu, P., Khan, Q., Chadha, R., Alghamdi, S., Shankar, S., Shaker, T., Fernandez, T., Yoon, U., Al-Hamoudi, W., Kantsedikas, I., Marquez, K. A. H., Elmikkaoui, B., Kostifa, E., Alshibi, L., Zachiotis, M., Raja, M., Dorvonis, P., Kareem, S. A., Bousi, S., Lewis, T., Turner, B., Chikkala, B., Hidalgo Salinas, C., Melloul, E., Wells, G., Syeda, G., Patel, K., Reji, N., Machairas, N., Tinguely, P., Staubli, S., Abdul Ghani, S., Grover, S., Oberkofler, C., Fernandez, T., Rahman Hakeem, A., Chan, A., Chorley, A., Galli, A., Kow, A., Malik, A., Rammohan, A., Pulitano, C., De Magnée, C., Zamora-Valdes, D., Mikulich, D., Kim, D., Jin Joo, D., Alconchel Gago, F., Lurje, G., Torres, G., Eilers, H., Ohdan, H., Braun, H., Montasser, I., Balradja, I., Shapiro, J., Ullah, K., Sun, L., De Boer, M., De Santibañes, M., Emara, M., Yasir Khan, M., Zayed, N., Selzner, N., Goldaracena, N., Keskin, O., Minnee, R., Chadha, R., Alabbad, S., Nah, S., Santoro, S., Zaragoza, A., Beridze, S., Mccluskey, S., Rahman, S., Junrungsee, S., Klair, T., Saluja, V., Zhu, Z., Shingina, A., Al-Judaibi, B., De Martin, E., Montasser, I., Bzeizi, K., Watt, K., Izzy, M., Berenguer, M., Zayed, N., Selzner-Malekkiani, N., Khan, Q., Jalan, R., Alghamdi, S., Alqahtani, S. A., Beridze, S., Al-Hamoudi, W., Alotaibi, A. F., Jagdale, A., Humar, A., Konietzko, A., Mohamed, A. M. I., Draz, A. R. I., Sabry, A. M., Shehta, A., Mehrez, A., Foda, A. S., Taha, A. M. I., Mohamed, A., Mohamed, I., Dogrul, A. B., Fukuda, A., Chan, A., Montano-Loza, A. J., Parente, A., Chorley, A., Della Penna, A., Duarte, A., Barbas, A., Pillai, A. A., Angelis, A., Campana, A. G., Campaña, A. G., Naomi, A., Lalisang, L. N. L., Oezcelik, A., Demir, A., Shah, A., Singhal, A., Khalil, A., Dahaba, A. A., Rammohan, A., Salah, A., Catellani, B., Fadel, B. A., Strobele, B., Elinoff, B., Balbi, B., Prabha, B., Elmikkaoui, B., Ruhi, C., Wilmans, C., Racke, C., De Magnee, C., De Magnée, C., Seng Gan, C., Hughes, C., Borja-Cacho, D., Caracciolo, D., Tholey, D., Fritze, D., Reynolds, D. M., Mitchell Reynolds, D., Kostrouch, D., Sass, D., Balci, D., Disabato, D., Broering, D. C., Clemens Broering, D., Raptis, D. A., Moris, D., Mostafa, D. K., Parbhoo, D., El-Gharabawy, D. A. R., Kostková, D., Domi, D., Abdel-Khalek, E. E., Elsayed Abdel-Khalek, E., Hassan, E. M. S., Mohamed, E., Hassan, S., Bonaccorsi Riani, E., Lytvak, E., Lytvyak, E., İsazade, E., Winter, E., Di Benedetto, F., Raziq, F. A. T., Martin, F., Krendl, F. J., Julius Krendl, F., Ulmer, F., Saner, F., Gondolesi, G. E., Eduardo Gondolesi, G., Sonmez, G., Sotiropoulos, G. C., Razzak, G. F. A., Abu Sharia, G. R., Spagnoletti, G., Meeberg, G., Ozturk, G., Torres, G. G., Guimarães Torres, G., Uchida, H., Karakayali, H., Oswari, H., Kato, H., Haq, I., Montesser, I. F., Fawzy Montesser, I., Shariffuddin, I. I., Balescu, I., Rodriguez, I. E., Krishnamurthy, J., Cisek, J., Shapiro, J. A. M., Schmidt, J., Singh, J., Uño, J. W., Walker Uño, J., Froněk, J., Caicedo, J. C., Cruz Fasolo, J., Jeffery, J., Ravindra, K., Mannogaran, K., Dokus, K., Degawa, K., William, K. Y., Dajani, K. Z., Olthoff, K. M., Dhanireddy, K., Hervera Marquez, K. A., Rinaldy, K., Vardar, K., Jnied, L. Y. Z., Chishtee, L. M. F., Matevish, L., Montes, L., Sun, L., Wei, L., Knipling, L., Jeng, L., Novellis, L., Auler, L. J. F., Podesta, L. G., Meteini, M. E. L., Singh, M. K., Schulze, M., Van Den Hove D’Ertsenryck, M., Chavez Villa, M., Beretta, M., Malago, M., Kočík, M., Byrne, M., Gryga, M., Huseynova, M., Bingol-Kologlu, M., Zubkov, M., Lucas, M., Bahaa, M., Abdel-Wahab Aly, M., Abdou, M. B., Alhazaimeh, M. A. K., Al-Rahman, M., Faisal, M., Schmelzle, M., Elshazly, M., Issa, M. A., Qadeer, M. A., Khan, M. Y., Yasir Khan, M., Zaheen, M., Tuul, M., Zeytinlu, M., Zayed, N., Makhlouf, N. A., Bacalbasa, N., Richter, N., Bergmann, N., Machairas, N., Bayramov, N., Kemmer, N., Keskin, O., Andacoglu, O. M., Selvi, O. C., Peralta, P., Kron, P., Bhanji, R., Chimakurthi, R., Alshwabkeh, R. A. A., S. K., R., Maciel, R. T., Walruff, R., Minnee, R., Porte, R., Hernandez Alejandro, R., Barth, R., Terng Ng, R., Kulkarni, R., Oberhuber, R., Komine, R., Shankar, S., Kara, S., Abu-Gazala, S., Goja, S., Yadav, S. K., Sakamoto, S., Kubal, S., Mogawer, S., Hsu, S., Nah, S. A., Anne Nah, S., Nadalin, S., Rashid, S., Schneeberger, S., Di Sandro, S., Hartleif, S., Kykalos, S., Gupta, S., Mushtaq, S., Baker, T., Klair, T., Kodama, T., Bitterman, T., Yilmaz, T. U., Utku Yilmaz, T., Rahayatri, T. H., Hening Rahayatri, T., Neumann, U. P., Baumann, U., Yoon, U., Saluja, V., Gunasekaran, V., Dhakshinamoorthy, V., Stephenne, X., Massoud, Y., Miyazaki, Y., Yanagi, Y., Dietch, Z., Abbas, Z., Kuloglu, Z., Hyder, Z., Zhu, Z., Global Outcomes of Open Versus Laparoscopic Versus Robotic Donor Hepatectomy: A Prospective Study From the International LDLT Registry (LDLTregistry.org), <<TRANSPLANTATION>>, 2026; 110 (1): 197-203. [doi:10.1097/TP.0000000000005530] [https://hdl.handle.net/10807/333388]

Global Outcomes of Open Versus Laparoscopic Versus Robotic Donor Hepatectomy: A Prospective Study From the International LDLT Registry (LDLTregistry.org)

Spagnoletti, Gionata;
2026

Abstract

BACKGROUND: Living donor liver transplantation is a critical solution to the global organ shortage. Comparisons of donor short-term outcomes according to the surgical approach are limited to a few single-center retrospective studies. This study aimed to evaluate the short-term outcomes of open, laparoscopic, and robotic surgical approaches to living donor hepatectomy using data from the prospective International Living Donor Liver Transplantation Registry (LDLTregistry.org). METHODS: Data from 2600 living donors undergoing hepatectomy were prospectively collected from September 2023 to February 2025. Donors were grouped into open (1726; 66.4%), laparoscopic (242; 9.3%), and robotic (632; 24.3%) approaches. RESULTS: The mean donor age was 33 (SD 9.4) y, with 45% women and a mean body mass index of 24.7 kg/m² (SD 6.5). Conversion rates were 15.3% for laparoscopic and 5.1% for robotic approaches (odds ratio, 0.30; 95% confidence interval, 0.17-0.50; P  < 0.001). Robotic hepatectomy was associated with the lowest intraoperative blood loss (70 mL; interquartile range, 50-100), lowest pain scores on postoperative day 1 (visual analog scale, 2.3; SD 1.9), and shortest hospital stay (4 d; interquartile range, 3-5). Robotic hepatectomy was associated with the lowest overall (grade ≥1; 4.6%) and major (grade ≥3a; 0.3%) complication rates compared with laparoscopic (16.5% overall, 3.7% major) and open (10.4% overall, 1.9% major) approaches ( P  < 0.001). CONCLUSIONS: This is the first global study to show evidence that robotic living donor hepatectomy offers superior short-term outcomes compared with laparoscopic and open approaches. Although open surgery remains the most common approach, robotic techniques show promise for improving donor safety and recovery.
2026
Inglese
TRANSPLANTATION
Rela, M., Pomfret, E., Egawa, H., Bhangui, P., Raptis, D. A., Berenguer, M., Spiro, M., Rela, M., Chaudhary, A., Humar, A., Shaked, A., Chan, A., Kow, A., Chieh, W., Jafarian, A., Singh Soin, A., Davidson, B., Goh, B., Chen, C., Miller, C., Chi Wang, C., Toso, C., Azoulay, D., Cherqui, D., Kruger, D., Balci, D., Manas, D., Bezinover, D., Jin Joo, D., Di Benedetto, F., Testa, G., Kabacam, G., Sapisochin, G., Eilers, H., Ozden, I., Findlay, J. Y., Pomposelli, J., Lerut, J., Dong, J., Liu, J., Fung, J., Roberts, J. P., Kim, J., He, K., Olthoff, K., Hasegawa, K., Hashimoto, K., Man, K., Watt, K., Patel, M. S., Cattral, M., Ghobrial, M., Malago, M., Kasahara, M., Ascher, N., Selzner-Malekkiani, N., Goldaracena, N., Bhangui, P., Jalan, R., Kamel, R., Adam, R., Troisi, R. I., Alqahtani, S. A., Nagral, S., Zheng, S., Nadalin, S., Asthana, S., Mccluskey, S. A., Gupta, S., Eguchi, S., Pan, T., Sakai, T., Cho-Lam Wong, T., Mas, V. R., Vohra, V., Vij, V., Polak, W., Andraus, W., Tokat, Y., Soejima, Y., Mayr, A., Dominguez, B., Muller, E., Rando, K., Mueller, T., Mayr, A., Raptis, D. A., Hidalgo Salinas, C., Spiro, M., Syn, N., Tinguely, P., Raptis, D. A., Prosperi, E., Spiro, M., Pomfret, E. A., Broering, D. C., Kirchner, V. A., De Martin, E., Shingina, A., Rammohan, A., Vinaixa, C., Borja-Cacho, D., Nasralla, D., Patel, D., Ann Wilson, E., Prosperi, E., Alconchel, F., Roll, G., Abdul, H., Liu, J., Shaji Mathew, J., Bzeizi, K., Patel, M. S., Izzy, M., Boehnert, M. U., De Santibanes, M., Zayed, N., Keskin, O., Andacoglu, O., Abreu, P., Khan, Q., Chadha, R., Alghamdi, S., Shankar, S., Shaker, T., Fernandez, T., Yoon, U., Al-Hamoudi, W., Kantsedikas, I., Marquez, K. A. H., Elmikkaoui, B., Kostifa, E., Alshibi, L., Zachiotis, M., Raja, M., Dorvonis, P., Kareem, S. A., Bousi, S., Lewis, T., Turner, B., Chikkala, B., Hidalgo Salinas, C., Melloul, E., Wells, G., Syeda, G., Patel, K., Reji, N., Machairas, N., Tinguely, P., Staubli, S., Abdul Ghani, S., Grover, S., Oberkofler, C., Fernandez, T., Rahman Hakeem, A., Chan, A., Chorley, A., Galli, A., Kow, A., Malik, A., Rammohan, A., Pulitano, C., De Magnée, C., Zamora-Valdes, D., Mikulich, D., Kim, D., Jin Joo, D., Alconchel Gago, F., Lurje, G., Torres, G., Eilers, H., Ohdan, H., Braun, H., Montasser, I., Balradja, I., Shapiro, J., Ullah, K., Sun, L., De Boer, M., De Santibañes, M., Emara, M., Yasir Khan, M., Zayed, N., Selzner, N., Goldaracena, N., Keskin, O., Minnee, R., Chadha, R., Alabbad, S., Nah, S., Santoro, S., Zaragoza, A., Beridze, S., Mccluskey, S., Rahman, S., Junrungsee, S., Klair, T., Saluja, V., Zhu, Z., Shingina, A., Al-Judaibi, B., De Martin, E., Montasser, I., Bzeizi, K., Watt, K., Izzy, M., Berenguer, M., Zayed, N., Selzner-Malekkiani, N., Khan, Q., Jalan, R., Alghamdi, S., Alqahtani, S. A., Beridze, S., Al-Hamoudi, W., Alotaibi, A. F., Jagdale, A., Humar, A., Konietzko, A., Mohamed, A. M. I., Draz, A. R. I., Sabry, A. M., Shehta, A., Mehrez, A., Foda, A. S., Taha, A. M. I., Mohamed, A., Mohamed, I., Dogrul, A. B., Fukuda, A., Chan, A., Montano-Loza, A. J., Parente, A., Chorley, A., Della Penna, A., Duarte, A., Barbas, A., Pillai, A. A., Angelis, A., Campana, A. G., Campaña, A. G., Naomi, A., Lalisang, L. N. L., Oezcelik, A., Demir, A., Shah, A., Singhal, A., Khalil, A., Dahaba, A. A., Rammohan, A., Salah, A., Catellani, B., Fadel, B. A., Strobele, B., Elinoff, B., Balbi, B., Prabha, B., Elmikkaoui, B., Ruhi, C., Wilmans, C., Racke, C., De Magnee, C., De Magnée, C., Seng Gan, C., Hughes, C., Borja-Cacho, D., Caracciolo, D., Tholey, D., Fritze, D., Reynolds, D. M., Mitchell Reynolds, D., Kostrouch, D., Sass, D., Balci, D., Disabato, D., Broering, D. C., Clemens Broering, D., Raptis, D. A., Moris, D., Mostafa, D. K., Parbhoo, D., El-Gharabawy, D. A. R., Kostková, D., Domi, D., Abdel-Khalek, E. E., Elsayed Abdel-Khalek, E., Hassan, E. M. S., Mohamed, E., Hassan, S., Bonaccorsi Riani, E., Lytvak, E., Lytvyak, E., İsazade, E., Winter, E., Di Benedetto, F., Raziq, F. A. T., Martin, F., Krendl, F. J., Julius Krendl, F., Ulmer, F., Saner, F., Gondolesi, G. E., Eduardo Gondolesi, G., Sonmez, G., Sotiropoulos, G. C., Razzak, G. F. A., Abu Sharia, G. R., Spagnoletti, G., Meeberg, G., Ozturk, G., Torres, G. G., Guimarães Torres, G., Uchida, H., Karakayali, H., Oswari, H., Kato, H., Haq, I., Montesser, I. F., Fawzy Montesser, I., Shariffuddin, I. I., Balescu, I., Rodriguez, I. E., Krishnamurthy, J., Cisek, J., Shapiro, J. A. M., Schmidt, J., Singh, J., Uño, J. W., Walker Uño, J., Froněk, J., Caicedo, J. C., Cruz Fasolo, J., Jeffery, J., Ravindra, K., Mannogaran, K., Dokus, K., Degawa, K., William, K. Y., Dajani, K. Z., Olthoff, K. M., Dhanireddy, K., Hervera Marquez, K. A., Rinaldy, K., Vardar, K., Jnied, L. Y. Z., Chishtee, L. M. F., Matevish, L., Montes, L., Sun, L., Wei, L., Knipling, L., Jeng, L., Novellis, L., Auler, L. J. F., Podesta, L. G., Meteini, M. E. L., Singh, M. K., Schulze, M., Van Den Hove D’Ertsenryck, M., Chavez Villa, M., Beretta, M., Malago, M., Kočík, M., Byrne, M., Gryga, M., Huseynova, M., Bingol-Kologlu, M., Zubkov, M., Lucas, M., Bahaa, M., Abdel-Wahab Aly, M., Abdou, M. B., Alhazaimeh, M. A. K., Al-Rahman, M., Faisal, M., Schmelzle, M., Elshazly, M., Issa, M. A., Qadeer, M. A., Khan, M. Y., Yasir Khan, M., Zaheen, M., Tuul, M., Zeytinlu, M., Zayed, N., Makhlouf, N. A., Bacalbasa, N., Richter, N., Bergmann, N., Machairas, N., Bayramov, N., Kemmer, N., Keskin, O., Andacoglu, O. M., Selvi, O. C., Peralta, P., Kron, P., Bhanji, R., Chimakurthi, R., Alshwabkeh, R. A. A., S. K., R., Maciel, R. T., Walruff, R., Minnee, R., Porte, R., Hernandez Alejandro, R., Barth, R., Terng Ng, R., Kulkarni, R., Oberhuber, R., Komine, R., Shankar, S., Kara, S., Abu-Gazala, S., Goja, S., Yadav, S. K., Sakamoto, S., Kubal, S., Mogawer, S., Hsu, S., Nah, S. A., Anne Nah, S., Nadalin, S., Rashid, S., Schneeberger, S., Di Sandro, S., Hartleif, S., Kykalos, S., Gupta, S., Mushtaq, S., Baker, T., Klair, T., Kodama, T., Bitterman, T., Yilmaz, T. U., Utku Yilmaz, T., Rahayatri, T. H., Hening Rahayatri, T., Neumann, U. P., Baumann, U., Yoon, U., Saluja, V., Gunasekaran, V., Dhakshinamoorthy, V., Stephenne, X., Massoud, Y., Miyazaki, Y., Yanagi, Y., Dietch, Z., Abbas, Z., Kuloglu, Z., Hyder, Z., Zhu, Z., Global Outcomes of Open Versus Laparoscopic Versus Robotic Donor Hepatectomy: A Prospective Study From the International LDLT Registry (LDLTregistry.org), <<TRANSPLANTATION>>, 2026; 110 (1): 197-203. [doi:10.1097/TP.0000000000005530] [https://hdl.handle.net/10807/333388]
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