# Achievements, Challenges and Promises of Minimally Invasive Liver Transplantation

## TL;DR

This review discusses the progress, challenges, and future potential of minimally invasive techniques in liver transplantation.

## Contribution

The paper provides a comprehensive overview of recent developments and gaps in minimally invasive liver transplantation.

## Key findings

- Minimally invasive liver transplantation has shown rapid progress in the last two decades.
- Technological advancements like 3D visualization and robotic systems are central to these developments.
- There is a growing number of publications and adoption of these techniques globally.

## Abstract

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.