A Guide to Robotic Kidney Transplant Surgery - by Dr. Rajesh Ahlawat, Chairman, MBBS, MS, MNAMS, Fellowship

Dr. Rajesh Ahlawat, Group Chairman, Urology and Andrology, Kidney and Urology Institute, Medanta Hospital, Gurugaon is one of the best urologists in India with more than 39 years of experience. Dr. Ahlawat pioneered the first Robotic Kidney Transplant Surgery in the world. 

Dr. Ahlawat pioneered the establishment of Urology and Renal Transplant programs in India at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Fortis Hospitals, New Delhi, Indraprastha Apollo Hospital, New Delhi, and Medanta, Gurugram. 

After completing his MBBS and MS from King Georges Medical College, Lucknow, Dr. Ahlawat pursued MCh in Urology from AIIMS. His area of specialization includes Robotic Kidney Transplant, Endourology, Laparoscopic and Robotic Urology, and Nephrectomy. 

He is a member of prestigious organizations including the Urological Society of India (USI), National Academy of Medical Sciences, American Urological Association (AUA), Endourology Society, and Society Internationale de Urology.

Dr. Rajesh Ahlawat has won several prestigious awards including the Chakraborty Fellowship by the American Urology Association & the PN Berry Fellowship, the President's Gold Medal by USI in 2016, and the Agra Urological Club Best Video (First Prize), 2003.

Robotic Kidney Transplant

Kidney Transplant has become a standard treatment for patients suffering from kidney failure. Technological advancements have enabled kidney transplants to be done by minimally invasive procedures with robotic support. Traditional kidney transplant surgeries require large incisions in the abdominal area which increases the risks of the surgery. Robotic kidney transplant surgery has transformed kidney transplant surgeries. 

Robotic Kidney Transplant Procedure 

Robotic Kidney Transplant surgery is carried out through a small incision (approx. 2.75 inches) above the belly button and 4-5 smaller incisions or “keyholes” to insert robotic laparoscopic instruments including a high-definition 3D camera. 

This 3D camera provides a magnified view of the site of surgery to the surgeon(s) at the console. The donor's kidney is inserted into the abdomen or the diseased kidney is brought out (if necessary) through the incision above the belly button. The ureter and blood vessels are attached by high-precision robotic instruments controlled by trained transplant surgeon(s) at the console. 

Benefits of Robotic Kidney Transplant

• Technical advantage 
  • The robotic instruments replicate the movements of the surgeon but are more precise and defter. They are not prone to human errors or conditions such as hand tremors.
  • The robotic arm has 360 degrees flexibility – which a wrist does not have. The surgeon can guide the instrument to operate in areas that are too deep or narrow.
• Improved Outcomes for Obese patients
  • Obese patients had to wait longer for transplants which led to poor patient outcomes. Robotic kidney transplant surgery helps to lower the risk of site infections in obese patients.
  • Robotic kidney transplant surgery makes it possible for obese people to undergo transplants. Earlier, morbidly obese people were not recommended for a kidney transplant. 
• Faster Recovery
  • A smaller incision means a lower risk of infection and blood loss
  • Shorter hospital stays
  • Less scarring
  • Lesser pain
• Research
  • Traditional surgery for kidney transplants is a standard procedure and there are not many innovative approaches that can be applied to it. Robotic kidney transplant allows scope for research for every aspect of the surgical procedure.

Risks of Robotic Kidney Transplant

Although minimal, there are certain risks associated with a robotic kidney transplant. They can be:

• Damage to nearby organs/blood vessels/nerves
• The kidney may change position or twist after the surgery
• Small hernias may develop in the keyholes

Robotic Kidney Transplant Costs

Robotic kidney transplant costs depend on factors including:

• The quality of the robotic system or equipment being used
• The skills and experience of the kidney transplant team
• Complications and post-operative care required 
• Duration of the hospital stay
• Additional tests conducted, especially for patients with a history of diabetes, hypertension, obesity, and other conditions

Conclusion

Robotic kidney transplant is a safer option than traditional kidney transplant surgery and has given a chance at survival to those who may have had none. While the risk for rejection of the donor kidney remains at par for traditional and robotic kidney transplant surgery, the latter manages to greatly reduce the risk for surgical site infection and improve patient outcomes.