Johns Hopkins has begun using a robotic technique for living donor liver donations, lowering risks of hernias and infections and reducing recovery time and postoperative pain for people who donate the organ.

Robotic liver resections were first performed in 2003, primarily to remove cancers. The technique is recognized as a safe and less invasive alternative to traditional surgeries, though it has not been universally adopted because it requires specialized equipment and training.

Though robotic liver resections are becoming more common, it is still rare to use the technique for living liver donations, which require that the surgeon preserve the organ so it can be transplanted to a recipient. Johns Hopkins is one of just a handful of institutions in the United States that use the robotic method for live liver donations.

Benjamin Philosophe, surgical director of the Johns Hopkins Comprehensive Transplant Center, had performed more than 250 robotic liver resections before leveraging his expertise for resections of donor livers. Since starting the robotic liver donor resections in December 2024, he’s done more than 35. All live-liver donor resections at Johns Hopkins are now robotic, he says.

With this technique, patients who donate are discharged in four to five days, he says, instead of five to seven, and heal more quickly at home. “They’re back to their normal routine much quicker because they don’t have the muscle healing, and the fascia incisions are not as large,” he says.

More Precision Needed for Donor Surgeries

While the procedure is fundamentally the same as for a robotic liver resection to remove cancer or another mass, removing a liver that will be donated requires more precision, Philosophe says. “You have to preserve the blood vessels and bile ducts in such a way as to allow reconnection in the recipient,” he says. “This sometimes requires reconstruction that you wouldn’t normally do for non-transplant cases.

“When you’re taking part of the liver out for reasons like cancer, you only worry about getting it all out and not leaving anything behind. You tie off the artery, tie off the vein, cut it out and send it to the pathologist. You don’t have to preserve the blood vessels or bile ducts.”

Another nuance, he says, is deciding how much of the liver to remove so that it’s a good fit for the recipient, while leaving enough for the donor. In most cases, the donor’s remaining liver regenerates relatively quickly and functions as well as before.

Philosophe says live liver donations with the robotic approach are more prevalent in other parts of the world, where organ donation after death is not common. In the U.S., he says, only about 10% of liver donations are from living donors, with about 600 such procedures performed annually nationwide. “You could count on one hand the number of U.S. programs that are doing the robotic approach consistently now,” he says.