Minimally Invasive Donor Hepatectomy

Minimally invasive donor hepatectomy (MIDH) involves either laparoscopic or robot-assisted technique, with the graft being retrieved through a remote incision. Current evidence reports faster recovery and better quality of life following MIDH than open donor hepatectomy, although these are limited to a handful of high-volume transplant centers. Nonetheless, grafts obtained by MIDH have a slight disadvantage of having shorter vein lengths than its open counterpart. Additionally, biliary complications are more prevalent in recipients of grafts retrieved by laparoscopic technique, while those obtained by the robotic platform demonstrate biliary complication rates comparable to, or even better than, those from open donor hepatectomy. Widespread application of MIDH has still not occurred across the world. This narrative review explores the challenges faced by the transplant surgeons when transitioning from open donor hepatectomy to MIDH, standard technique of robotic donor hepatectomy and suggests strategies to overcome the learning curve. It compares laparoscopic and robotic donor hepatectomies, detailing the advantages and disadvantages of each approach, as well as their outcomes.