Robotic Liver Transplant Surgery - Procedure, Benefits & Result

A robotic liver transplant is an advanced, minimally invasive procedure. It uses robotic arms to assist surgeons in performing hepatic transplantation with high precision. The technique involves making small incisions, which reduces trauma to the body compared to open surgery.

Anatomy and Physiology of the Liver

The liver is situated in the upper right abdominal region, below the diaphragm and above the stomach, right kidney, and intestines. It is divided into two primary lobes, known as the right lobe and the left lobe. Each lobe is divided into smaller lobules that form the common hepatic duct. 

It performs more than 500 vital functions, including bile production, regulating blood clotting, and clearing toxins from the blood. It has a dual blood supply: 

1. Hepatic Artery: Delivers oxygenated blood from the heart

2. Hepatic Portal Vein: Brings nutrient-rich blood from the stomach, intestines, pancreas, and spleen 

This minimally invasive robotic liver surgery can be used to treat various severe liver conditions. These include the following: 

• Liver Cirrhosis: Advanced scarring of the liver caused by chronic hepatic diseases like hepatitis or long-term alcohol abuse.

• Hepatitis A, B, and C: Severe cases of viral hepatitis that lead to significant liver damage.

• Non-Alcoholic Fatty Liver Disease: Inflammation of liver cells due to fat build-up in the liver.

• Primary Sclerosing Cholangitis: Chronic liver disease resulting from swelling and scarring of the bile ducts.

• Biliary Atresia: A congenital condition where the bile ducts are blocked or absent, leading to liver damage.

• Liver Cancer: Malignant tumours in the liver that are not responsive to other treatments.

• Genetic Liver Diseases: These include conditions such as Wilson’s disease (excessive copper build-up in the liver) or haemochromatosis (accumulation of iron in the liver).

Candidates for a robotic-assisted liver transplant are typically selected based on several qualifying factors. These aspects are as follows: 

1. End-stage liver disease or severe hepatic dysfunction that impacts the quality of life

2. No significant comorbidities like chronic liver infection that could complicate the procedure

3. Other medical and surgical treatments do not improve the condition

This technique represents a significant advancement in medical technology, providing numerous benefits over traditional methods. The robotic liver transplant advantages are as follows:

• Minimally Invasive: It involves smaller incisions compared to traditional open surgery, causing less trauma to the body.

• Improved Precision and Control: This allows for more accurate and delicate movements during the procedure.

• Reduced Blood Loss: Smaller incisions and precise techniques result in less bleeding during surgery.

• Faster Recovery: Robotic liver transplant recovery is typically quick with shorter hospital stays.

• Smaller Scars: Minor incisions result in minimal scarring, which can be cosmetically favourable.

• Enhanced Visualisation: The high-definition 3D camera provides a detailed view of the surgical area, enabling better identification and preservation of critical structures.

Preparing for a robotic hepatectomies surgery involves several crucial steps to achieve the best possible outcome. Being well-informed about pre and post-operative care ensures patients are ready for the procedure.

Before the Robotic Liver Surgery

The table above shows the preparation required before robotic liver transplant surgery. Patients undergo pre-operative assessments and receive instructions for fasting and medication restrictions.

On the Day of the Robotic Liver Transplant

Patients complete last-minute formalities at the hospital on the day of the procedure. They undergo a physical evaluation before the surgery.

A liver transplant surgery with robots is performed by experienced gastrointestinal surgeons. It is done under general anaesthesia and usually takes about 8 hours. The steps are as follows:

1. A surgeon makes several small incisions in the abdomen to insert the robotic arms and a high-definition 3D camera.
2. They position the robotic system and control the arms via a console near the operating table.
3. Mechanical arms are used to insert the instruments through the incisions.
4. The surgeon uses robotic instruments to detach the diseased liver from the blood vessels, organs, and structures.
5. They guide robotic arms to extract the liver.
6. The healthcare provider places the liver of the living or deceased donor and connects it to the recipient’s blood vessels and nearby structures.
7. The surgical area is inspected for any bleeding or issues.
8. If there is no bleeding, the surgeon closes the incisions with sutures or surgical staples.

Performing a robotic liver transplant in India has been a remarkable experience. I feel it is the perfect blend of cutting-edge technology with the intricate skill required for the efficacy of such a complex procedure. The precision and minimally invasive nature of robotic surgery has enhanced patient recovery, and seeing the exceptional positive outcomes and improved quality of life for my patients is truly satisfactory.”

- Dr. K R Vasudevan

MBBS, MS General Surgery, DNB Surgical Gastroenterology

The recovery time after RLDH surgery is usually quicker than the open technique. The initial recovery takes about 2-4 weeks. However, it may take 6-8 weeks before returning to normal activities. 

In-Hospital Recovery

Robotic liver surgery outcomes vary from person to person. Usually, the hospital stays after a robotic liver transplant ranges from 2 to 3 days, based on the individual’s condition and recovery speed. During this time, patients can expect the following:

1. The team shifts the patient to a recovery room, where they closely monitor the vital signs and post-anaesthetic effects. 

2. Once the vitals stabilise, the patient is moved to an ICU. 

3. The doctor prescribes pain medications to manage discomfort. 

4. Frequent blood tests are conducted to monitor liver function and detect organ rejection. 

5. Once the breathing tubes are removed, individuals can start drinking fluids and eating solid foods, which usually happens after one to two days. 

At-Home Recovery

This period focuses on continuing the healing process at home. Proper care and adherence to medical advice during this time are essential for ensuring a successful recovery. Patients should follow the below-mentioned guidelines:

1. Keep the surgical area clean and dry to prevent infections. 

2. Take all prescribed medications as directed, especially immunosuppressants, to prevent organ rejection.

3. Follow a nutritious diet plan recommended by the healthcare team to support healing and overall health.

4. Gradually resume light activities to improve physical and mental health. However, avoid heavy lifting and strenuous exercises for at least a month. 

5. Refrain from driving for about a week. 

First Follow-Up Appointment

The follow-up appointment takes place within the first week or two after discharge from the hospital. During this visit, the surgeon removes stitches, examines recovery, and checks the functioning of the liver. Further consultations are scheduled for every two to four weeks.  

Robotic Liver Transplant Success Rate

On the basis of the patient’s overall health and the specific circumstances of the surgery robotic liver transplant success rate depends. According to a study by Raptis et al., 2024, the 5-year survival rate of the graft is 90% for paediatrics and 79% for adults.

A study conducted by Schulze et al., 2022, revealed that 12% of recipients needed re-transplantation after the procedure. The robotic liver transplant risks include the following:

1. Bile duct issues, such as leaks or shrinkage
2. Uncontrolled bleeding
3. Infections
4. Rejection of the transplanted liver
5. Failure of the new liver

When is consultation with a doctor needed?

After this minimally invasive liver transplant, patients should monitor their health closely. Individuals must call their healthcare provider immediately if they notice any of the following:

1. Fever above 100.4 F
2. Yellowing of the skin or eyes (jaundice)
3. Abdominal pain
4. Fatigue or weakness
5. Persistent nausea and vomiting
6. Diarrhoea
7. Shortness of breath and chest pain
8. Reduced urine output

The price of a robotic liver transplant procedure in India varies depending on several factors. The cost starts at ₹ 20,00,000 and reaches ₹ 33,00,000. The average expense is about ₹ 25,00,000.

Note: These expenses are approximate. Patients are advised to consult HexaHealth experts for the most current and accurate pricing.

The factors that affect the cost of robotic liver transplants are:

1. Surgeon’s Expertise: Highly experienced surgeons with specialised training in robotic procedures may charge more for their services.
2. Hospital Facilities: The cost varies based on the location, reputation, and quality of services offered at the medical centre.
3. Geographic Location: Prices can differ depending on the city where the surgery is performed. Metropolitan cities are usually costlier than small towns.
4. Type of Donor Liver: The source of the donor liver (living donor vs deceased donor) and related procurement costs can affect expenses.
5. Pre-operative Assessments: The number and complexity of tests required before the surgery can impact the overall expenditure.
6. Insurance: The extent of insurance coverage can impact out-of-pocket costs.

Robotic liver transplant surgery is revolutionising the field with its minimally invasive approach and high precision. This cutting-edge technique results in reduced recovery times, less postoperative pain, and minimal scarring. It offers a promising alternative if you require a liver transplant.

HexaHealth can assist you with the complexities of robotic liver transplant surgery. We connect you with top medical professionals and offer support throughout your treatment. Discover the numerous liver transplant surgery benefits with our expert guidance and personalised care.

Also Read

• Types of Liver Transplant
• Unknown Facts about Liver Transplant Surgery
• Laparoscopic Liver Transplant
• Orthotopic Liver Transplant
• Paediatric Liver Transplant
• Risks and Complications After a Liver Transplant