Anesthetic management of totally robotic right lobe living-donor hepatectomy: new tools ask for perioperative care.

Abstract

Living donor transplantation is an accepted clinical practice in select transplant centers in Western countries to increase the availability of organs, while is standard practice in East Asian transplant programs. Living-donor right hepatic lobe resection is a particularly risky operation, with two mandatory outcomes: no serious complications for the donor, and an optimal graft-recipient body weight ratio. The use of robotic surgery has increased worldwide thanks to its minimally invasive approach, and is now becoming suitable for living donor procurement. From the anesthetic point of view, robotic surgery reveals itself to be extremely challenging, and requires diverse capacities in teamwork and planning of anesthetic management. We report what we believe is the first case of anesthetic management of a totally robotic right lobe resection in a living donor, and describe the steps taken by the anesthetists, in concert with the surgical team, to ensure delivery of the safest patient care.