Liver transplantation is a necessary life-saving procedure for end-stage liver disease. Deceased donors contribute 95% of the organs required for liver transplantation across the US and Europe. However, the scarcity of deceased donors has made live donor liver transplantation (LDLT) the predominant modality (90%) in Asia. Morbidity and mortality of the donor are understandably the most feared repercussions associated with LDLT. In the A2ALL cohort study,¹ even though mortality was rare (0.7%), morbidity was considerable (38%). Donor hepatectomy is commonly performed through a large upper abdominal incision, often midline or right subcostal with midline extension. The associated wound pain, adhesive intestinal obstruction, incisional hernia, and poor cosmesis constitute a major part of donor morbidity, delaying a return to normal activities. A minimally invasive approach using a smaller, more cosmetic remote incision has been the aspiration of living donor surgeons for many years. While laparoscopy is widely used for minimally invasive donor nephrectomy, a similar adoption of laparoscopic donor hepatectomy (LDH) has not materialized. Laparoscopic live donor left lateral hepatectomy, first performed in 2002, and laparoscopic right donor hepatectomy, reported a decade later, are still confined to a few large volume LDLT centers.² An obligate prerequisite for performing LDH is a combination of many years of experience in LDLT and advanced skills in laparoscopy. The amalgamation of these 2 disparate skills necessitates a steep learning curve. Softening this curve by using a robotic platform to perform minimally invasive live donor hepatectomy (MIDH) is the innovation.

肝移植是终末期肝病必不可少的挽救生命的程序。已故捐赠者贡献了美国和欧洲肝移植所需器官的 95%。然而，已故捐献者的稀缺使得活体肝移植（LDLT）成为亚洲的主要方式（90%）。可以理解，供体的发病率和死亡率是与 LDLT 相关的最可怕的影响。在 A2ALL 队列研究中，¹尽管死亡率很少（0.7%），但发病率相当高（38%）。供体肝切除术通常通过一个大的上腹部切口进行，通常是中线或右肋下，中线延伸。相关的伤口疼痛、粘连性肠梗阻、切口疝和美容不良构成了供体发病率的主要部分，延迟了恢复正常活动。使用更小、更美观的远程切口的微创方法多年来一直是活体供体外科医生的愿望。虽然腹腔镜广泛用于微创供体肾切除术，但腹腔镜供体肝切除术 (LDH) 的类似采用尚未实现。2002 年首次进行的腹腔镜活体肝左外侧切除术和十年后报道的腹腔镜右肝切除术，²执行 LDH 的一个强制性先决条件是多年的 LDLT 经验和腹腔镜检查的先进技能的结合。这两种不同技能的融合需要陡峭的学习曲线。通过使用机器人平台进行微创活体肝切除术 (MIDH) 来软化这条曲线是一项创新。