Robotic-Assisted Living Donor Nephrectomy
A decade ago laparoscopic technology revolutionized the field of surgery,
creating a new generation of minimally invasive procedures. Today, surgeons
at the Renal and Pancreas Transplant Division have taken that technology
one step further. They are using robotics to perform both living donor
nephrectomies (kidney removal) and implantation of the kidney into the
In fact, Stuart R. Geffner, M.D., Director of Kidney and Pancreas Transplant
Surgery, The Renal and Pancreas Transplant Division, is the first in the
world to use the Intuitive Surgical's da Vinci ™ Surgical System
to successfully implant a kidney into a living recipient. This procedure
revolutionizes kidney transplant surgery, taking an open procedure to
an advanced form of laparoscopic surgery.
"Robot-assisted technology is a remarkable surgical tool. It's
an advanced form of laparoscopic surgery that allows us to do precision
work with less trauma to the patient," states Dr. Geffner.
How it Works
Utilizing the da Vinci Surgical System, the surgeon sits in a console a
few feet from the patient and views the surgical site through a high-definition
3D viewer. A laparoscopic camera and robotic probes (arms) are inserted
into the patient through four half-inch incisions. The surgeon uses hand
controls and foot pedals to manipulate the robotic arms. These pencil-sized
probes translate the surgeon's hand movements and adjust themselves
to compensate for the natural tremor of the human hand. Dr. Geffner notes
that the equipment can be set to make the tiniest movements with rock-steady
The end of the robotic arm articulates 360 degrees, affording complete
range of movement. "It gives us much greater dexterity and range
of motion, more so than the human wrist," explains Dr. Geffner. "Therefore,
when we remove or implant a kidney we greatly reduce the amount of tissue
damage." The donor kidney is removed fully intact through a small
three-inch bikini line incision. With robotics, the implantation requires
a 5 cm incision which is just large enough to introduce the kidney into
the recipient’s body. It is approximately one-third the size of
a conventional “open” transplant incision.
Benefit to Donors and Recipients
For the patient, robot-assisted surgery is safe, minimally invasive and
offers faster recovery time. Patients usually leave the hospital within
a day or two and resume normal activity shortly thereafter.
Dr. Geffner hopes that this new technology and the ease with which kidneys
can be removed will encourage more people to become living donors. Nearly
75,000 people in the United States are waiting for a kidney transplant.
Many have to wait three to five years before they find a match. A shortage
of living donors is one reason for the long wait.
As Dr. Geffner concludes, "Robotics is a technology that will clearly
evolve. It's only going to get better, for our patients as well."