Surgeons at Washington University School of Medicine in St. Louis said they recently completed the first robotic liver transplant in the U.S.

The team successfully performed the transplant in May utilizing minimally invasive robotic surgery at Barnes-Jewish Hospital. According to the university’s website, the smaller incision results in less pain and faster recoveries. Meanwhile, the precision capabilities of surgical robotics enabled the team to perform “one of the most challenging abdominal procedures.”

According to the university, the 60-year-old man who received the transplant had liver cancer and cirrhosis caused by hepatitis C. He is currently doing well and has resumed normal, daily activities. This starkly contrasts to standard liver transplant recipients, who generally need at least six weeks before walking without any discomfort. The patient not only began walking easily one month after surgery but also received clearance to golf and swim.

Transplant surgeon Dr. Adeel Khan serves as the leader of the team that conducted the surgery and as an associate professor of surgery at the School of Medicine. Khan said the operation “went smoothly” and the patient recovered without any surgical complications. While the patient’s physical recovery has been on schedule, he did require extra time in the hospital due to cognitive symptoms that are not unusual in older patients after major surgery.

How traditional liver transplants work

Traditional liver transplants take place as an open procedure, the university says. A surgeon makes a 3- to 4-inch vertical and 12- to 16-inch horizontal incision just below the rib cage to remove a patient’s diseased liver and place the healthy donated liver. Smaller incisions in minimally invasive methods could result in less pain and faster recoveries, though.

However, most transplant surgeries may be too complicated for that approach. Diseased livers may lead to excessive bleeding during removal surgery, according to the team. Attaching a new liver to the circulatory system requires delicately sewing several tiny blood vessels together, too.

“Liver transplantation is one of the most complex abdominal operations and heavily relies on a specialized team for good outcomes,” Khan said. “Here at Washington University and Barnes-Jewish Hospital, we are very fortunate to have the support needed to develop a world-class robotic-transplant team that allows us to safely perform complex operations. This team is a big part of our success.”

How the robotic liver transplant compares

In this robotic liver transplant, the surgeons operated through half-inch keyhole incisions, plus a single 6-inch vertical incision between the abdominal muscles. Using this incision, they removed the diseased organ and placed the new liver (about the size of a football) inside the abdomen. The six-inch incision is “considerably smaller” than the traditional incision and does not require cutting through abdominal muscles. The team says this enables a faster recovery.

This robotic liver transplant took just over eight hours. According to Washington University, traditional open liver transplants usually take between six and eight hours. Future robotic liver transplants could finish faster as the operating team gains experience and acclimates to the subtleties of the new technique.

While the team says this marks the first robotic liver transplant in the U.S., a South Korean team reported the first global one in 2021. That involved transplanting half a liver from a living donor, rather than the whole organ, in a partially robotic surgery. Khan says his team is the first to perform a robotic liver transplant in which a whole liver was transplanted.

“Liver transplantation is the most difficult of the abdominal organs to consider for a minimally invasive approach — given the difficulty of removing a failing liver and successfully implanting the new organ — but Dr. Khan has shown that this is possible,” said Dr. William Chapman, the Eugene M. Bricker Professor of Surgery, director of Washington University’s Division of General Surgery and chief of the transplant surgery section. “Further experience with this technique will be needed to establish the extent of the benefits of performing liver transplant as a minimally invasive approach.”

Plenty of transplant experience

The team at Washington University and Barnes-Jewish Hospital focus heavily on robotic surgery, they said. They formed the team five years ago with an initial focus on kidney transplants, performing more than 30 robotic kidney transplants to date. All reported positive outcomes.

The team also performs living-donor kidney removal surgery, plus robotic surgeries for the liver, bile ducts, pancreas and stomach.

“Over the span of several years, we have built a dedicated robotic transplant team that is second to none and has been instrumental to our success,” Khan said. “Once we had this team in place, it allowed us to grow in both number and complexity of the cases while maintaining very good patient outcomes. … We are probably one of the very few places in the country that has the support, expertise and team to take robotic transplant surgery to this level.”