Robotic Liver Transplant

Overview

An evolving speciality within liver surgery, a robotic liver transplant is an advanced alternative to liver transplant surgery. Surgeons usually perform liver transplants to replace a damaged or non-functioning liver—a result of liver failure—with a healthy liver. In a robotic liver transplant, this replacement surgery is done using mechanical arms instead of the surgeon’s hands or a laparoscope. This makes the surgery much more minimally invasive than other forms of liver transplant surgery, improving surgical outcomes and precision.

Alternate Name

Robotic hepatectomy

Body Location

Liver

How is it Performed?

Liver transplants are reserved for people with untreatable complications due to terminal liver diseases. The source of the healthy liver can be a deceased (cadaveric or non-living) donor or a living donor. In a robotic liver transplant surgery, mechanical arms make smaller incisions than in a typical open or laparoscopic surgery. The latter is used to extract the liver from the donor (hepatectomy) and graft it in the recipient (transplant).

The surgeon first marks the incision sites on the abdomen of both the donor and the recipient, following which small incisions facilitate the insertion of the instruments by the mechanical arms. The incisions also allow the movement of a camera arm, which enables visualization—yielding a 3D view of the surgical site. The surgeon controls these arms through a console near the operating table.

Using these arms, the surgeon carefully separates the damaged liver from the nearby blood vessels, organs, and structures, and secures it. The arms then remove the damaged liver. Next, the arms place the new liver and re-attach them to the nearby structures and blood vessels. Once the blood flow is restored and there is no residual bleeding, the surgeon closes the incisions with sutures and applies a sterile dressing at the surgical site. The site is monitored for a few days after the operation to check for infections. The doctors also assess whether the body has accepted the transplanted organ.

Preparation

Before the liver transplant surgery:

• The doctor will analyze your medical history, and you will be required to undergo tests to ensure you are healthy enough to receive the organ.
• Once deemed fit, you might undergo a compatibility test to prevent rejection of the transplanted organ in the case of a live donor.
• This is followed by a pre-anaesthesia check-up, following which the surgery will be scheduled.
• The doctor will ask you to fast for at least 8 hours before the surgery.
• On the day of the surgery, the doctor will brief you about the procedure and record your last meal details. They may also give you medicines to help you relax.
• You will have to sign a consent form, after which you will be asked to change into a gown and remove all jewellery, piercings, etc., from your body. A nurse might prepare the surgical site by shaving if required.
• Next, you will be connected to a machine that records your heart rate, blood pressure, breathing, etc., following which you will be shifted to the operation theatre.

Procedure Type

Surgical

Follow-up

Once the procedure is completed, the surgical team will monitor your vitals and anaesthesia and escort you to the ICU. For a few days post-operation, the medical team will collect blood samples at specific intervals to ensure that the new liver is functioning properly. These are critical to recognize organ rejection which can lead to complications.

If the tests come back as expected, you may be allowed to start eating solid food and moving as and when the doctor sees fit. However, this will all still be strictly monitored to ensure no post-op infections or complications occur.

Even after you resume activity, you may be required to stay at the hospital for a few days. If everything goes well, the doctor will give you instructions and ask you to visit them for follow-up check-ups.

Once discharged, you will be asked to avoid strenuous physical activity and lifting any objects that may cause your stitches to rip. Additionally, your doctor might suggest you join a support group for transplant rehabilitation.

Risks

Liver transplant surgery is a serious surgery and hence carries significant risks. It is reserved only for people with end-stage liver disease or liver failure. Some of its risks are:

• Complications of the bile duct, such as leaks or shrinkage.
• Uncontrolled bleeding from the surgical site
• Rejection of the liver
• Post-op infections
• Failure of the transplanted liver

Recovery

While complications such as bleeding are usually lower with a robotic liver transplant, there is still a significant amount of care that needs to be taken during recovery.

Liver transplant surgeries often warrant lifestyle changes. You must ensure a well-rounded and balanced diet to keep the body healthy. Dietitians recommend lowering the salt, fat, sugar, and cholesterol intake post-liver transplant surgeries. Eating high-fibre foods, whole grains over processed ones, and reducing dairy intake is also recommended. If you are on immunosuppressants to avoid rejection of the liver, you might be asked to avoid foods like grapefruits as they can interfere with these medicines.

One of the most significant changes is to avoid alcohol. This is because alcohol is typically the cause of end-stage liver failure (cirrhosis). If required, your doctor can support you with an alcohol-recovery rehabilitation centre to help you avoid alcohol.

After a liver transplant surgery, you are recommended to incorporate a healthy amount of exercise in your daily life to continue improving your physical and mental health. Low-impact strength training and walking are good starter options. However, this must be done under your surgeon's guidance to avoid incorporating anything strenuous.