*Purpose: Robotic surgery is emerging as a surgical technique to enable resection of the liver using minimally invasive techniques; however, very few living donor liver transplantation centers have reported their experience with totally robotic donor hepatectomy.

*Methods: This is a retrospective review of our initial series of robotic donor hepatectomy focusing on operative feasibility and early post-operative outcomes.

*Results: From June to September 2018, our living donor liver transplantation program performed our first 4 totally robotic donor hepatectomy operations. Surgeons involved in these cases were both accredited for living donor surgery and robotic surgery. Our program’s experience include >300 donor hepatectomy and >100 robotic procedures (90% of which were robotic hepatobiliary operations). There were 3 female and 1 male donor (average age 33). We performed 2 robotic right hepatectomy (RH) and 2 robotic left lateral segmentectomy (LLS) for live donation. The recipients were all relatives; 2 adults (primary biliary cirrhosis and primary sclerosing cholangitis), and 2 children (alpha-1-antitrypsin deficiency and biliary atresia). Average estimated graft weight was 903g (RH) and 220g (LLS). Average GBWR was 1.01 (adult recipients) and 2.04 (pediatric recipients). Average procedure time was 558mins (RH) and 424mins (LLS) while transection time was 228mins (RH) and 150mins (LLS) . All grafts were extracted via Pfannenstiel incisions. It took us an average of 11.75 minutes from cross-clamp to flush. Estimated blood loss was 175mls (RH) and 150mls (LLS). Conversion rate was zero. Average highest postoperative bilirubin was 2.4mg/dL (RH) and 1.3mg/dL (LLS). INR did not rise above 1.6 for any donor. One LLS donor had a bile leak which resolved after 4 days; there were no other 90-day post-operative complications. Average length of hospital stay was 5.5 days. There was zero incidence of small for size syndrome, early vascular or biliary complications in the recipients. All donors reported excellent patient satisfaction with the surgery and post-operative course.

*Conclusions: In conclusion, totally robotic donor hepatectomy appears feasible for selected patients in centers with large experience in living donor liver transplantation and complex robotic hepatobiliary surgery.

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