Surgeons at Washington University School of Medicine in St. Louis have become the first in the world to robotically transplant an entire liver, resulting in a less painful, faster recovery, and proving that one of the most complex abdominal procedures can be performed in a minimally invasive fashion.

The procedure was performed in May at Barnes-Jewish Hospital on a man in his 60s with liver cancer and cirrhosis caused by the hepatitis C virus. While an open liver transplant requires at least six weeks of recovery before a patient can walk without discomfort, the man was able to walk and resume physical activities one month afterward, according to Dr. Adeel Khan, an associate professor of surgery at the School of Medicine who led the team during the procedure.

“The operation went smoothly, the new liver started working right away, and the patient recovered without any surgical complications,” he said in a statement.

The surgeons made several half-inch keyhole incisions which they operated through, and a single six-inch vertical incision that is smaller than the one in traditional surgery between the abdominal muscles to remove the liver and put in the transplant. The team did not have to cut through the abdominal muscles, speeding up the man’s recovery, though he did require extra time in the hospital due to cognitive symptoms not unusual in older patients following surgery.

The procedure took a little over eight hours but was within the expected time frame of six to eight hours for traditional open liver transplants. Khan says that timing will become shorter as the team becomes used to the technique.

Liver transplants, along with other organ transplants, were long thought too complex to perform as minimally invasive procedures. In 2021, surgeons in South Korea performed the first robotic liver transplant, but with half a liver from a living donor in a partially robotic surgery.

“Further experience with this technique will be needed to establish the extent of the benefits of performing liver transplant as a minimally invasive approach,” 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.

In time, the technique will likely be performed in other U.S. hospitals, since the transplant service team at Washington University mentors over 30 transplant centers across the country on building robotic programs of their own. The team currently has five surgeons and will add two more by the end of the summer.

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