09:07am Thursday 21 September 2017

Allegheny General Hospital Surgeons Perform Region’s First Robotic-Assisted Kidney Donation

An altruistic kidney donor from western Pennsylvania is recovering well today after becoming the first patient in the region, and one of just a handful in the country, to undergo robotic-assisted minimally invasive kidney removal surgery at Allegheny General Hospital (AGH). 

AGH’s abdominal transplantation team, led by surgeon Kusum Tom, MD, performed the groundbreaking procedure on June 30, 2011 using the hospital’s da Vinci Robotic Surgical System. Upon extraction, the donor kidney was flown to Columbia University Medical Center in New York, where it was successfully transplanted into a 65 year-old man with end stage renal disease.

Dr. Tom was assisted on the case by AGH transplant surgeon Akhtar Khan, MD.

The AGH donor, who has requested anonymity, said offering his kidney to a complete stranger came down to a simple desire to “significantly improve someone’s life.” As it turns out, he accomplished that and much more as his donation launched a country-wide chain of kidney transplants organized by the National Kidney Registry.

Dr. Tom said the extraordinary generosity of living donors motivates transplant professionals to do everything they can to ease the trauma of donation.

In 1998, AGH transplant specialists were the first in Pittsburgh to perform laparoscopic donor kidney nephrectomy using conventional hand held scopes and surgical tools. The da Vinci Robotic Surgical System takes the laparoscopic approach to a whole new level, further minimizing the invasiveness of the procedure and enhancing the patient’s experience.

“With da Vinci, our minimally invasive surgical capabilities are advanced considerably, resulting in even less pain, and a faster recovery for our donor patients,” Dr. Tom said.

AGH’s first robotic-assisted kidney donor went home the day after the procedure. Conventional laparoscopic donor nephrectomy surgery typically requires a 3-4 day hospital stay, Dr. Tom said. The donor kidney is also functioning well for the recipient.

Originally developed by NASA for operating remotely on astronauts in space and used by the Department of Defense to operate on soldiers in the battlefield, the da Vinci Surgical System is the world’s most advanced surgical robot, allowing surgeons to see targeted anatomy in high magnification, brilliant color and a natural depth of field. The System’s robotic instruments exceed the natural range of motion of the human hand and afford a fail-safe design that minimizes the possibility of human error.

Sitting comfortably at a remote console several feet away from the operating room table, the surgeon maneuvers da Vinci’s robotic arms stationed at the patient’s side and views the surgical field through a high resolution, three dimensional endoscopic camera mounted on one of them.

The da Vinci camera and robotic arm instruments are inserted into the patient through three half-inch incisions. Using hand controls and foot pedals to manipulate the robotic arms, the fully intact kidney is removed through a small, three lower abdominal incision.

Unlike conventional laparoscopic surgery, where surgeons must look up and away from hand held instruments to a nearby monitor to see the targeted anatomy, da Vinci keeps the surgeon’s eyes and hands positioned in line with the instruments at all times.

“This is a remarkable technology that substantially improves hand-eye coordination and reduces the physical toll of the procedure on the surgeon. The high magnification of the robot allows us to better visualize and dissect blood vessels and by translating the surgeon’s hand motions into micro-movements that reduce even the most minute of tremors, we are able to remove a donor kidney with even greater precision and confidence,” said Ngoc Thai, MD, PH.D, Director of AGH’s Center for Abdominal Transplantation.

According to Dr. Thai, living donation transplants are generally more successful than cadaveric kidney transplants because the organ preservation time is shorter and the tissue match is usually better between the donor and the recipient.

“Hopefully, as the option of robotic minimally invasive surgery becomes more readily available to potential donors, it will encourage more people to consider donation,” he said.

The United Network for Organ Sharing (UNOS) estimates that approximately 70,000 people are currently on the waiting list for kidney transplantation in the United States. The majority of kidney transplant recipients are able to return to a normal, healthy life after surgery.


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