The number of individuals registered and waiting for a liver transplant is near 11,000.
Matching a patient in need of an organ transplant with a healthy liver is critical, but an innovative surgical procedure is expected to expand the pool of eligible donors.
VCU Health Hume-Lee Transplant Center, the United States’ only center actively offering robotic hepatectomies, which is the surgical removal of portions of living donors’ livers, is using a less invasive robotic liver procurement procedure.
The center is the third in the U.S. to successfully perform the innovative surgery, and performed its first fully robotic hepatectomy in April 2023.
“The Hume-Lee Transplant Center has a legacy of surgical innovations to improve the experience and outcomes for donors and recipients alike,” Dr. David Bruno, interim chair of Hume-Lee and Virginia Commonwealth University School of Medicine’s Division of Transplant Surgery, said. “Our goal remains to find the best match for every patient who needs an organ, and our advancements with robotic liver procurement ease some physical burdens on living donors as they make lifesaving and life-changing decisions.”
Robotic surgery is less invasive, therefore, donors can recover quicker with less pain and less scarring, and more quickly return to normal activities while the remaining portion of their liver regenerates. A major advantage is that surgeons can avoid making a significant abdominal incision which cuts through muscle. That muscular healing is often the toughest part of a donor’s recovery. Robotic surgery moves the main incision below an individual’s belt line.
In late July, Hume-Lee hosted global liver transplant pioneer Dr. Gi Hong Choi, who has performed more than 150 robotic procurement surgeries, to provide hands-on robotic expertise in more complex cases and to enhance team members’ skills. Choi partnered successfully with Hume-Lee liver transplant surgeons on two hepatectomies on donors who didn’t meet conventional criteria; one with a larger than normal liver and one with abdominal scarring from a previous surgery. The robotic system’s enhanced precision allows surgeons to adapt to complex anatomical conditions that previously excluded would-be donors from eligibility, while continuing to perform safe and effective procedures.
“VCU has very active transplant surgeons who will have widespread success with the robotic living liver donor program,” Choi, professor of surgery at Yonsei University in South Korea, said. “There is pioneering work being done here … to provide minimally invasive surgery for donors with great expected outcomes.”
The robot’s four arms carry a camera scope, guided by a surgeon at the controls, and instruments into the body via four small punctures to remove a part of the living donor’s liver. The system provides magnification of up to 10 times the human eye, pinpointing accuracy and stability in moving tissue and making incisions.
According to Choi, the robotic function allows surgeons to overcome two limitations of laparoscopic surgery: the so-called “fulcrum effect,” where the device’s motion is more restricted at the incision, and limited movement within the very compact area that houses the liver. The organ also must be handled precisely to protect its complex and delicate vascular anatomy.
“There was great collaboration between the VCU Health doctors during the surgery. We discussed the patient’s anatomy and how to standardize the procedure with complex cases, which is a very important path,” Choi said. “With full support of the hospital leaders, active surgeons and the entire transplant team, VCU Health is in a very important position to lead this type of advanced robotic surgery for living donors.”
Approximately 9,000 liver transplants are performed every year, according to the United Network for Organ Sharing, leaving a shortage of organs for every patient who needs one.
“By and large, most living donors are given to help a relative, which are often the best medical matches for recipients,” Bruno, who implanted both procured organs from the robotic hepatectomies where Choi assisted, said. “The more we expand the criteria for those who can donate, the faster we can make those matches.”
VCU Medical Center has performed robotic surgeries since 2014, when it launched the surgical system. A minimally invasive surgery division was established in July 2019. VCU Health became one of the first hospitals to perform a living-donor liver transplant in 1998.
Virginia is one of 25 states with medical centers that perform living donor liver transplants, according to the Organ Procurement and Transplantation Network.
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Rebecca Barnabi
