By Matthew Brady 
Prof. Dieter C. Broering, Executive Director, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, shares insights on the future of robotic transplants in this exclusive Q&A with HealthTechAsia.
Your team has already achieved significant progress in robotic transplants. What would you say has been particularly successful? Which areas still require improvement?
We have been extremely fortunate at KFSHRC to pioneer some landmark achievements in robotic transplant surgery, including the world’s first fully robotic living donor liver transplant and the first robotic left-lobe liver transplant from a living donor.
These milestones have demonstrated how robotic techniques can successfully address even anatomically complex cases with remarkable precision and versatility. Between 2018 and 2025, the Organ Transplant Centre (OTC) performed 841 adult and 470 pediatric robotic-assisted liver donor procedures, establishing KFSHRC as one of the most experienced centres globally in robotic transplant surgery. Robotic surgery has translated into improved patient outcomes, with high graft survival rates, reduced surgical trauma, and a quicker return to everyday life for donors and recipients.
That said, there are areas where further progress is needed. Robotic systems continue to require significant upfront investment and specialised infrastructure, which can limit broader national and regional adoption. Moreover, the field requires a steep learning curve, even for experienced surgeons.
To address this, KFSHRC launched a structured robotic transplant fellowship, focused on donor nephrectomy, hepatopancreatobiliary (HPB) surgery, and liver transplantation, helping to standardise training and ensure consistent outcomes across future surgical teams.
Finally, while robotic systems have advanced considerably, current platforms still lack haptic feedback (i.e. the ability to physically “feel” tissue resistance, texture, or subtle differences in pressure), which remains a limitation during highly delicate surgical tasks. Integrating real-time imaging technologies and augmented reality (AR) overlays could further enhance surgical precision and safety, and we are closely monitoring innovations in this field.
How do outcomes from robotic transplants compare with traditional methods regarding recovery, success rates, and long-term health?
At KFSHRC, we have seen that robotic transplant procedures significantly reduce surgical trauma, leading to quicker recovery times, less postoperative pain, and shorter hospital stays for both donors and recipients compared to traditional open surgery. Patient survival and graft success rates are comparable, and in select cases superior, to conventional approaches, particularly when performed in high-volume, specialised centres such as KFSHRC.
Beyond the immediate surgical outcomes, early evidence also suggests that robotic transplant surgery promotes a faster return to work and daily activities and better cosmesis, contributing meaningfully to an improved quality of life for our patients. These advantages further reinforce the value of integrating robotics into advanced transplant programs.
Are there any limitations to using robotics in organ transplantation?
One major challenge is the high upfront investment and ongoing maintenance costs, which can limit adoption, particularly for institutions with constrained resources. In addition, the steep learning curve associated with robotic surgery requires surgeons to complete extensive simulation-based training and supervised clinical experience, which can slow down broader implementation.
Operationally, prolonged setup times and the lack of haptic feedback can affect surgical efficiency and make specific technical steps more demanding. Robotic systems may also be less suitable in urgent transplant scenarios, where the setup speed is critical to patient outcomes. Finally, maintaining a robotic program requires consistent procedural volume. Without it, the cost-benefit ratio becomes difficult to justify, limiting the scalability of robotic transplantation to select high-volume centres.
How is AI currently being integrated into robotic systems, and what are your thoughts on the role of AI in this field?
This is a great question, a common topic for discussion in several scientific meetings worldwide. Artificial intelligence may transform robotic surgery, with newer platforms integrating AI for improved instrument control and anatomical recognition. However, the potential for AI extends far beyond current applications. Future integrations could include real-time predictive analytics for intraoperative complications, AI-driven tissue differentiation, and even autonomous surgery.
At KFSHRC, we are advancing AI priority initiatives in transplantation, from AI-enhanced multidisciplinary team meetings and patient evaluation to automated operation reports, telemonitoring, and AI-powered pathology, all aimed at optimising transplant outcomes through data-driven innovation.
What ethical or regulatory considerations do you encounter with robotics and AI in surgery?
Integrating robotics and AI into surgery brings essential ethical and regulatory responsibilities. Accountability remains critical, requiring clear frameworks to determine responsibility when AI-supported systems influence outcomes.
Integrating AI into robotic surgery presents several ethical and regulatory challenges that must be carefully addressed. Key concerns include ensuring patient data privacy and establishing clear accountability frameworks for AI-assisted decisions. Regulatory bodies must define standards for AI validation, real-time performance monitoring, and surgeon oversight to maintain patient safety. As we move toward AI-enhanced robotic systems, proactive collaboration between clinicians, developers, and policymakers will be essential to address these challenges responsibly.
How does the surgeon’s role change as robotics advances?
Robotic surgery presents several challenges. The primary concerns are: ensuring proper surgeon training and credentialing given the steep learning curve, maintaining patient safety through rigorous processes, addressing the high costs that may limit equitable access to these advanced procedures, and establishing clear guidelines for when and how robotic approaches are most appropriate.
What training or upskill is required for surgeons to work effectively with robotic systems?
Practical training often starts with simulation-based programs to allow surgeons to build proficiency in a controlled, no-risk environment before performing live cases, followed by official certification. Mastery of the robotic console, strong troubleshooting abilities, and lateral thinking are critical skills surgeons must develop to manage complex intraoperative situations effectively.
Participation in standardised training programs is increasingly becoming a best practice to ensure consistent competency across different centres. As mentioned earlier, at KFSHRC, we have taken a structured approach by establishing a 12-month Speciality Fellowship in Robotic Transplant and HPB Surgery. Importantly, ongoing competency-based assessments are integral to maintaining a high patient safety and clinical excellence standard as the field evolves.
How do you see the role of robotics in surgery evolving over the next few years?
Over the next few years, we anticipate broader applications across several procedures, including cases involving pediatric procedures. Robotic systems are evolving rapidly and we expect them to become even more innovative platforms, integrating augmented reality (AR) overlays, and AI-driven decision support to guide surgeons through complex anatomy with exceptional accuracy.
At KFSHRC, we are already preparing for this shift. By achieving global firsts, such as fully robotic liver and heart transplants, we have demonstrated what is surgically possible when precision, data, and robotics combine. The hospital continues to invest in next-generation systems, training, and ethical technology integration to ensure we remain at the forefront of robotic evolution and can offer our patients optimal care.
In which other areas of surgery or medical innovation do you see promise? For instance, there has been some discussion — and even early adoption — of Virtual Reality/Augmented Reality, and remote surgery. What’s your take on these developments?
Beyond robotic surgery, several groundbreaking innovations may well further transform transplantation. At the forefront is xenotransplantation, where recent advances in genetic engineering and immunosuppression protocols have brought us closer to viable clinical applications. While still experimental, successful porcine-to-human heart, kidney, and liver transplants mark significant milestones that could eventually address the organ shortage crisis.
We also see tremendous potential in Virtual and Augmented Reality (VR/AR) technologies for advanced surgical training through hyper-realistic simulations and intraoperative navigation, where AR overlays enhance anatomical visualisation. Additionally, remote telesurgery continues to evolve as a promising solution to expand access to specialised transplant care globally, though it requires overcoming substantial technical and regulatory limitations.
At our centre, we are particularly focused on how these innovations can work synergistically, combining robotic precision with xenotransplantation science and digital visualisation tools to push the boundaries of what is possible in transplant medicine.
Cleveland Clinic