By: Maria-Paula

VCU Health Hume-Lee Transplant Center surgeons are using a less-invasive robotic liver procurement procedure to expand the pool of eligible living liver donors. As the number of people registered and waiting for a liver nears 11,000, the innovative process represents a critical breakthrough in matching liver transplant patients with healthy living donors.

Hume-Lee Transplant Center is the only active facility in the nation offering robotic hepatectomies – the surgical removal of portions of living donors’ livers – being the third U.S. center to successfully perform this innovative surgery. The center 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. 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,” said David Bruno, M.D., interim chair of Hume-Lee and Virginia Commonwealth University School of Medicine’s Division of Transplant Surgery.

Since robotic surgery is less invasive, donors recover sooner with less pain and less scarring as the remaining portion of their liver regenerates. This therefore enables them to quickly return to normal activities.

A major advantage of robotic hepatectomies is that surgeons do not have to make abdominal incisions which cut through muscles that take long to heal, often the toughest part of a donor’s recovery. Robotic surgery instead moves the main incision below an individual’s belt line.

In late July, Hume-Lee hosted Gi Hong Choi, M.D, professor of surgery at Yonsei University in South Korea and a global liver transplant pioneer who has performed more than 150 such surgeries successfully partnered with Hume-Lee liver transplant surgeons on two hepatectomies done on donors who didn’t meet conventional criteria. With an aim to provide hands-on robotic expertise in more complex cases and to enhance team members’ skills using a robotic surgical system on the patients, one with a larger than normal liver and the other with abdominal scarring from a previous surgery, the surgery was aimed at providing hands-on robotic expertise in more complex cases and to enhance team members’ skills. The robotic system’s enhanced precision therefore allows surgeons to adapt to complex anatomical conditions – including those two cases – that previously excluded would-be donors from eligibility, while continuing to perform safe and effective procedures.

“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.”

Hume-Lee’s Vinay Kumaran, M.D., living liver donor surgical director, and Seung Duk Lee, M.D., associate surgical director of liver transplant, last fall traveled to South Korea, where living-donor transplants are more common. There, the surgeons observed operations to capture insights on leveraging a robotic system to procure a portion of a liver from a living donor.

“VCU has very active transplant surgeons who will have widespread success with the robotic living liver donor program,” said Professor Choi. “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 and instruments into the body via four small punctures to remove a part of the living donor’s liver, with a surgeon controlling the robot. The system provides magnification of up to 10 times the human eye, pinpointing accuracy and stability in moving tissue and making incisions.

Although liver implantation surgery is still commonly performed through traditional open surgery due to the complexity of the donor recipient’s procedure, Professor Choi noted that the robotic function allows surgeons to overcome two major limitations. Laparoscopic surgery also 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 is also handled precisely to protect its complex and delicate vascular anatomy.

“By and large, most living donors are given to help a relative, which are often the best medical matches for recipients,” said Bruno, who implanted both procured organs from the robotic hepatectomies where Choi assisted. “The more we expand the criteria for those who can donate, the faster we can make those matches.”

For recipients in failing health, living donors can provide timelier access to organs, instead of longer waits for a deceased donors organ. Too often, patients who opt for a deceased liver might be too frail for a transplant once they are near the top of the list. According to the United Network for Organ Sharing, about 9,000 liver transplants occur each year, leaving a shortage of organs for every patient who needs one.

According to the Organ Procurement and Transplantation Network, Virginia is one of 25 states with medical centers that perform living donor liver transplants.

VCU Medical Center notes it has been performing robotic surgeries since 2014, when it launched this surgical system. Hume-Lee established a minimally invasive surgery division in July 2019. In 1998, VCU Health became one of the first hospitals to perform a living-donor liver transplant.