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Surgeons Use New High-Definition Robot During Living-Donor Kidney Transplant

September 28, 2017

Surgeons at Rush University Medical Center are performing living-donor kidney transplants using a new high-definition robotic surgery system that offers improved precision, shorter recovery and smaller incisions for the donor patient.

Utilizing the new high-definition da Vinci S Surgical System, the surgeon sits in a console a few feet from the patient and views the surgical site through a high-definition three dimensional viewer. The laparoscopic camera and robotic arms are inserted into the patient though four half-inch incisions. The surgeon uses hand controls and foot pedals to manipulate the robotic arms in the mechanically-assisted surgery. The fully intact kidney is removed through a small three inch bikini line incision.

According to Dr. Kalyan Latchamsetty, a laparascopic surgeon at Rush, the robotic surgery offers many advantages over conventional laparoscopy surgery, in which the surgeon operates through small incisions using hand-held, long-shafted instruments.

With conventional laparoscopy, the surgeon must look up and away from the instruments to a nearby two-dimensional video monitor to see an image of the target anatomy. The surgeon must also rely on an assistant to position the camera correctly.

In contrast, the da Vinci System's design allows the surgeon to see the target anatomy in high-definition 3-D and operate from a comfortable, seated position at the console, with eyes and hands positioned in line with the instruments.

"The robotic-assisted surgery improves hand-eye coordination. We are able to perform the donor nephrectomy with greater precision, confidence and comfort," said Latchamsetty. "In addition, we have greater dexterity. The ends of the da Vinci tools articulate 360ยบ offering complete range of movement, even more than the human wrist. It is a vast improvement over operating with chopstick-like conventional laparoscopic instruments."

For the donor patient, a robot-assisted procedure can offer all the benefits of a minimally-invasive procedure, including less pain, less blood loss and less need for blood transfusions.

Patients have a shorter hospital stay, a quicker recovery and faster return to normal activities. Implantation of the donor kidney into the recipient still requires conventional surgery.

Nearly 73,000 people in the U.S. are waiting for a kidney transplant according to the Organ Procurement and Transplantation Network (UNOS). Many of those patients will have a long wait, on average from three to five years before they find a match. One reason for the long wait is because there are not enough living donors.

"Robotic-assisted surgery is safe, minimally invasive, and offers faster recovery for the living-donor. We believe this advancement will encourage people to be more willing to donate kidneys and thus expand the potential pool of organ donors," said Dr. Deepak Mital, kidney transplant surgeon at Rush University Medical Center.

According to Mital, living donation transplants are usually more successful than cadaver donors because there is a short preservation time and often better tissue match between the living donor and the recipient. The higher rate of compatibility also decreases the risk of organ rejection. Additionally, because the surgery can be scheduled in advance, the patients with worsening renal failure may avoid the need for dialysis before the transplant. The transplant is scheduled with the donor and recipient's work and social schedules in mind. Kidney donors undergo extensive medical screening and can expect to lead a normal life after donation.

A successful kidney transplant saves lives and restores the quality of life for patients with end stage renal disease. It eliminates the need for maintenance dialysis, allowing the patients greater freedom and less restrictive diets. Most kidney recipients return to work and lead a full life after transplant.

rush.edu.