In a major advancement for liver transplantation, a multidisciplinary team at NewYork-Presbyterian and Weill Cornell Medicine successfully performed New York’s first fully robotic liver transplant in which both the living donor and recipient surgeries were done robotically, placing the institution at the forefront of innovation in minimally invasive liver transplant surgery.
On May 27, 2025, a 63-year-old female patient with primary biliary cirrhosis underwent the robotic liver transplant using a portion of a liver donated from her 24-year-old nephew. The team leading her care included:
- Juan Rocca, M.D., MHA, attending surgeon at NewYork-Presbyterian and Weill Cornell Medicine and surgical director of the Weill Cornell Medicine Liver Cancer Program, who led the procedure on the recipient;
- Benjamin Samstein, M.D., chief of liver transplantation and hepatobiliary surgery at NewYork-Presbyterian and Weill Cornell Medicine, who led the living donor surgery;
- Peter Liou, M.D., transplant surgeon at NewYork-Presbyterian and Columbia, who was an attending surgeon on the recipient’s surgery;
- Dustin Carpenter, M.D., transplant surgeon at NewYork-Presbyterian and Weill Cornell Medicine, who was also an attending surgeon on the recipient’s surgery;
- Robert Brown, M.D., chief of the Division of Gastroenterology and Hepatology at NewYork-Presbyterian and Weill Cornell Medicine, who was the recipient’s transplant hepatologist;
- Russell Rosenblatt, M.D., M.S., medical director of the living donor program at NewYork-Presbyterian and Weill Cornell Medicine, who was the donor’s transplant hepatologist.
From left: Dr. Rosenblatt, Dr. Samstein, Dr. Rocca, and Dr. Brown.
The surgery was the second milestone achieved in less than two months, as in April the same team had performed the institution’s first fully robotic liver transplant with a deceased donor organ on a 59-year-old male recipient with decompensated liver cirrhosis, marking rapid progress for the robotic liver surgery program.
“These milestones are a testament to the teamwork and advancements we have made over the past several years to take on more difficult operations, with the goal of improving outcomes for more patients with liver cancer, living liver donors, and now, liver transplant recipients,” says Dr. Rocca.
“Liver transplantation is among the most morbid surgeries. In some cases, hospitalizations can last for weeks and with open surgery, full recovery can take up to six months,” says Dr. Samstein. “But medicine is changing to be less morbid, and surgeries like these usher in a period where long hospitalizations for severe disease may become a thing of the past.”
Dr. Rocca, left, demonstrating use of a surgical robot.
Preparing for a Successful Transplant
Although living donor hepatectomies have been performed robotically at NewYork-Presbyterian and Weill Cornell Medicine since July 2023, “this was a first for us to have two fully staffed robotic teams operating at the same time,” says Dr. Rocca. Each operating room was equipped with the latest robotic technology and staffed with a surgical team composed of nurses, anesthesiologists, physician assistants, two surgeons at the bedside, and Dr. Rocca and Dr. Samstein at the robotic consoles. “Our nurses are very invested and the support we have from the operating room team is amazing,” Dr. Rocca adds. “Everybody wanted to make this surgery a success, and it was.”
Patient selection also played a critically important role. “The living donor recipient was a good candidate as she was in end-stage liver disease but wasn’t too sick yet,” says Dr. Rocca. “That period of time allows us to achieve the best outcomes with a live donor, so we decided to transplant her in her early phase rather than waiting for her to become sicker.”
During preoperative discussions with the patients, “we explained that we were trying something new, which can be scary, but that we have a lot of safeguards and checkpoints,” he adds, including a plan to convert to open surgery in the case of complications such as excessive bleeding.
During the transplant surgery, Dr. Rocca used five minimally invasive ports and a lower abdomen incision to explant the diseased liver. The living donor graft was inserted through the incision and the vascular and biliary anastomoses were done robotically. One potential challenge with performing a living donor transplant robotically is that the connections when dealing with half a liver can be more delicate.
Left: Dr. Rocca getting an initial visualization of the liver prior to the insertion of the robotic ports for the recipient’s surgery.
Right: Dr. Liou (left) and Dr. Carpenter at bedside during the surgery.
Photos courtesy of Nishtha Singh/Weill Cornell Medicine.
“You’re dealing with smaller arteries, smaller bile ducts, and veins that can be more difficult to put together,” says Dr. Rocca. “But the anatomy of the donor was very simple and the recipient was in good shape, so we felt they were the best case to start with.” Additionally, the magnification from the robot allows for better precision in stitching without tremor.
Both operations took about eight hours and were completed without major complications. The donor was discharged within six days, and the recipient within nine days.
A Multiphase Path to Innovation
Dr. Rocca joined NewYork-Presbyterian and Weill Cornell Medicine in 2022 to lead the growth of robotic integration into liver surgery, and the dual robotic surgeries mark the latest stage of a carefully planned progression that occurred in five stages:
- Stage one: Simple hepatectomies to treat liver cancer
- Stage two: Complex hepatectomies to treat liver cancer
- Stage three: Living donor hepatectomies
- Stage four: Liver transplants using a deceased donor
- Stage five: Liver transplants using a living donor
Although robotic procedures can involve similar or longer operative times than laparoscopic or open surgery, the team found that perioperative outcomes were superior, prompting a full transition to robotic hepatectomies by 2023.
A study published in Surgical Endoscopy by Dr. Rocca, Dr. Samstein, and their colleagues documented that transition and its impact. The retrospective cohort analysis revealed significant improvements associated with robotic hepatectomy, including:
- 43% shorter average lengths of stay compared with open surgery
- 62% lower odds of complications compared with open surgery
- 87% lower odds of conversion to open hepatectomy when compared with laparoscopic surgery.
Redefining Standards in Transplant Surgery
NewYork-Presbyterian is only one of a handful of institutions in the U.S. that has the training, expertise, and infrastructure to perform robotic liver transplants using both deceased and living donor livers. “Robotic living transplantation is in its pioneer phase,” says Dr. Rocca. “And we’ve now achieved our ultimate goal: performing robotic transplantation using organs from live donors.”
Since the May surgery, the team has already performed a second fully robotic donor and recipient transplant, with plans to increase both living donor and deceased donor cases. “Our vision is to offer robotic transplant initially to a carefully selected group, perhaps 20% of recipients,” says Dr. Rocca. “But as our experience grows, so will access.”
Dr. Samstein also emphasizes that multidisciplinary innovation will contribute to future success. “We’re going to continue to see improvements in our immunosuppression and in our treatment of patients’ weight, kidney function, and hypertension,” adds Dr. Samstein. “All of those factors, along with our ability to innovate surgically, will help make liver transplant surgery faster, shorter, and safer.”
The technical success of this robotic liver transplant was, above all, rooted in both surgical training and team readiness. “Innovation in transplant surgery is always a team sport,” Dr. Rocca says. “This wasn’t the effort of one surgeon. It was years of investment, training, and trust across disciplines. And it’s only the beginning.”
