The Laennec technique: A potential candidate for the standardization of right robotic donor hepatectomies.

Abstract

Robotic donor hepatectomy lacks a standardized technique, contributing to variability in learning curves and outcomes across institutions. The Laennec approach utilizes the Laennec's capsule, the Glissonean pedicle sheath, and the middle hepatic vein to create a structured, reproducible dissection framework suited to the robotic platform. We report our experience with this approach at a high-volume United States transplant center. We retrospectively analyzed 35 consecutive patients undergoing the Laennec approach-guided robotic donor hepatectomy at a high-volume United States transplant center (Jan 2023-Apr 2025) on the da Vinci Xi platform and evaluated perioperative and postoperative outcomes. Median operative time was 446 min (range, 329-618), parenchymal transection time was 164 min (range, 115-319), and blood loss was 150 mL (range, 50-700). One case was converted to open surgery. Median peak total bilirubin was 2.75 mg/dL (range, 1.10-5.70), and peak alanine transaminase was 272 U/L (range, 138-652). The 90-day postoperative complication rate was 20%, with 1 postoperative bleeding event managed via laparoscopic re-exploration and no bile leaks or liver failure. Donor hepatic anatomy data demonstrated predominant single-vessel patterns for hepatic artery (96.4%) and portal vein (96.4%), with bile duct variants present in 71.4% of cases. The Laennec approach is safe and feasible for robotic donor hepatectomy at a high-volume United States transplant center, with outcomes consistent with published benchmarks and zero biliary complications. Its anatomy-based dissection sequence creates a structured, teachable operative framework that may serve as a template for robotic donor hepatectomy standardization. Multicenter prospective studies are needed to confirm broader applicability.