Robotics open the door for high-risk kidney transplants

At the University of Illinois Hospital at Chicago, we have been using robotic surgery to transplant high-risk kidney patients since 2010, when we did the first successful robotic kidney transplant in a morbidly obese patient.1 Since then with more than 18 years of experience using the surgical robot technology, we have successfully performed more than 250 kidney transplant surgeries with obese patients.

High-risk surgery

A significant portion of patients needing a kidney transplant are overweight or obese. Up to half of the dialysis patients are obese, defined as having a BMI of greater than 30 kg/m2.2 Patients with a BMI of greater than 40 kg/m2 who have ESRD are often denied transplantation because of being overweight.

Obese patients often have diabetes and hypertension as a result of being overweight. Seventy percent of patients on dialysis with hypertension and 75% of patients on dialysis with diabetes survive fewer than 5 years on dialysis, as previous research has shown.3 Transplant centers may avoid accepting high-risk morbidly obese patients for kidney transplantation due to the increased risks associated with surgery, wound infection, graft survival and patient safety. We often evaluate these patients to see if they are a fit for robotic-assisted kidney transplantation.

Enrico Benedetti, MD, FACS, professor and Warren H. Cole Chair in Surgery at the University of Illinois Hospital at Chicago, is using robotics to successfully perform high-risk transplant surgery.

Source: Jenny Fontaine

Robotic-assisted surgery makes a dramatic difference for obese patients because it significantly reduces the risk of wound infection and offers a safer, minimally invasive procedure with fewer complications.

Robotic surgical procedure

For these transplants, we have developed a new robotic technique that avoids any incision in the infection-prone lower abdomen and uses only a small incision above the belly button. In a traditional “open” kidney transplant procedure, a 6-inch to 8-inch incision is made in the right lower abdomen to implant the donor kidney, increasing the risk of the surgery. Of note, the risk of wound infection in patients with a BMI of greater than 40 kg/m2 is estimated at 35%.4 Our surgical team uses a robotic surgical system to transplant the kidney through a 2.75-inch incision above the patient’s belly button, and four tiny incisions in the abdomen to accommodate the robotic laparoscopic instruments.

Robotic surgery for morbidly obese patients can be accomplished safely and allows minimally invasive access without the visual and technical limitations of laparoscopic surgery. Current laparoscopic cameras provide only a 2-D view and laparoscopic instruments have a limited degree of freedom. In contrast, robotic surgery provides a 3-D view and utilizes instruments with 360° range of motion, allowing surgeons to complete more complex procedures.

Our results during the last 9 years have shown that obese patients who received robotic-assisted kidney transplants had fewer wound complications than patients who received traditional open transplant surgery.