Robotic Surgery

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 recipient.

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 precision.

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."

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