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A Retrospective Observational Study of the First 120 Robotic Hepatobiliary and Transplant Procedures at a Transplant Institute
Sofia Volpi1, Divya Randhawa1, Belen Rivera1, Vanessa Cowan1, Amy Evenson1, Angela Chen1, Vincenzo Villani1, David Lee1, Devin Eckhoff1, Martin Dib1 1. Division of Transplant Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
Background: The adoption of robotic hepatobiliary and transplant surgery has been slow due to technical complexity, leaving limited evidence on early implementation and outcomes. We describe the growth trajectory and clinical outcomes of the first 120 robotic hepatobiliary and transplant procedures performed at our institution. Methods: All robotic procedures performed at our center’s Transplant Institute between August 2024 and December 2025 were retrospectively reviewed. The cohort was divided into the first 60 procedures (Era 1) and the subsequent 60 (Era 2) to evaluate program evolution. Patient demographics, procedure complexity, thirty-day complications, Clavien-Dindo (CD) grade ≥IIIa complications, 30-day readmission, conversion to open surgery, reoperation, and mortality were analyzed. Results: A total of 120 robotic procedures were performed: 87 hepatobiliary (including major and minor hepatic resections), 31 transplant cases (9 living donor hepatectomies, 17 living donor nephrectomies, 4 kidney transplants, 1 liver transplant), and 2 renal vein reconstructions. Median age was 62 years (IQR 51–68), 45.8% were male. Era 1 occurred over a 10.5-month period, whereas Era 2 reached equal volume in 5 months, maintaining similar proportion of complex procedures (48% vs 50%, respectively). No cases required conversion to open surgery. Thirty-day complications decreased from 37% in Era 1 to 30% in Era 2, with CD ≥IIIa 12% vs 15%, respectively. Two reoperations occurred in Era 2, and readmission rates were equal across eras (10%). No 30-day mortality occurred. Conclusion: With the first 120 cases, the program demonstrated rapid growth in volume while maintaining procedural complexity and decreasing complication rates.
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