*Purpose: Robotic living donor has been performed in a few centers with good outcomes; the first report of a robotic right lobe donor hepatectomy was from the University of Illinois at Chicago (Giulianotti et al, 2012). Robotic left hepatectomy is established for other indications but its application to left lobe donation is complicated by caudate management. To date there is no reports of left hepatectomies for liver donation in the US. Morbidity in living donor hepatectomy is often related to abdominal wall trauma (pain, hernia, bowel obstruction) The aim of our project is to show our experience performing the first two reported Robotic Left Liver Lobe living donors and subsequent transplant in the country.

*Methods: We describe the first two reported to date purely robotic left liver living donation and the associated transplant outcomes. First donor was a 19 y/o with no significant comorbidities, recipient was a 24 y/o male with primary sclerosing cholangitis cirrhosis (PSC). Second donor was a healthy 34 y/o female, the recipient was a 67 y/o female with PSC. Appropriate preoperative workup was done according to our institution protocol, Imaging was obtained with 3D MEVIS reconstruction, donor was deemed to be a good candidate for a robotic left liver donation.

*Results: Donor #1 resulted in a Left liver graft of 475 gr (estimated 539gr) and Graft to Recipient Body Weight Ratio (GRWR) of 0.92, WIT of 7 minutes. Second donor graft size was 390 gr (projected 360gr) and GRWR of 0.74 and 9 minutes WIT. Both donors had an uneventful recovery with resumption of diet on postoperative day 1, return of bowel function on day 3 and discharge on day 5. Stable Ultrasounds on Day 1,2 and 6. Image 1 shows donor preoperative anatomy and intraoperative findings. Recipient #1 underwent piggyback caval , end to end portal vein, right hepatic to left hepatic artery anastomosis and roux en Y hepaticojejunostomy; He had severe malnutrition that required enteral support and was discharged on day 10 with overall good recovery. Recipient #2 underwent cavocavostomy, end to end portal vein, right hepatic to left hepatic artery and duct to duct anastomosis. Recovery was uneventful. Both recipients had normal ultrasounds on postoperative day 1,2,6 with a normal cholangiogram on day 6. Outpatient follow up has been unremarkable for both donors and recipients.

*Conclusions: Our study shows that robotic left liver living donation is a good surgical option with good outcomes for donor and recipient. This option should be offered to select donors based on body habitus and anatomic characteristics. Further studies will be needed to evaluate larger cohorts of patients at short and long term.

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