Achievements, Challenges and Promises of Minimally Invasive Liver Transplantation

The integration of minimal invasive (MIS) techniques in liver transplantation (LT) emerged as a natural progression following advances in laparoscopic and robotic hepato-pancreato-biliary surgery. However, it poses specific challenges that are inherent to LT. Chronologically, it is a recent topic that only emerged 2 decades ago in donors and recently in recipients, but it has showed a meteoric rise with tremendous progress over the last years. This review aimed to provide a comprehensive yet synthetic overview of the available data on minimal invasive liver transplantation (MILT), for both donor hepatectomy (DH), recipient hepatectomy and graft implantation. Developments were numerous: top-notch technical skills have not only been reported but have foremost been performed worldwide by an increasing number of groups. Technology also played a central role, as exemplified by the integration of 3D visualization techniques, the utilization of indocyanine green (ICG) near-infrared fluorescence camera system or the use of robotic technology. Research efforts finally illustrated this progress with a rapid rise of number of publications and adoption. The present analysis of the available data permitted to identify gaps that may be valuable to explore by future research projects.