Robotic surgery is the future of kidney transplant

Apart from being minimally invasive, which reduces scars and healing time, it also offers surgeons better vision and dexterity.
Transition from open to robotic assisted kidney transplant can be compared to the switch from landline to mobile.
Transition from open to robotic assisted kidney transplant can be compared to the switch from landline to mobile.

BENGALURU : Kidney transplant has been considered the best treatment option for chronic kidney disease patients who are on regular dialysis. The traditional, conventional and widely-accepted procedure for kidney transplant currently is open kidney transplant, however, innovations in medical science have introduced new methods that are beneficial to patients. Robotic assisted kidney transplant (RAKT) is one such innovation and it is here to stay, say doctors.

Transition from open to robotic assisted kidney transplant can be compared to the switch from landline to mobile, says Dr Deepak Jayaprakash Kaddu, consultant, robotic surgery and renal transplantation, Manipal Hospital Whitefield, Bengaluru.

Normally the kidney is transplanted in the lower part of the abdomen in the patient and the blood supply to the graft kidney is restored by joining it to the native blood vessels of the patient. An incision is made in the lower part of the abdomen to expose the blood vessels, join the kidney to them, and place the kidney in suitable position. However, in robotic kidney transplant surgery, all the steps are done using a surgical robot. An incision is made in the lower abdomen to deliver the graft kidney into the abdominal cavity of the patient, while rest of the steps are similar to those in laparoscopic surgeries, taking the help of a robot.

Less scarring and complications

Apart from being minimally invasive, which reduces scars and healing time, it also offers surgeons better vision and dexterity. “For the surgeon, robotic surgery affords considerable ease, reducing the fatigue which comes from a prolonged and focused procedure like a kidney transplant. The vision in the robotic console is a 10-times magnified, high-definition view - which allows the surgeon to suture the small vessels with absolute confidence and ease,” said Dr Shakir Tabrez, additional director, kidney transplant and robotic surgery, Fortis Hospital Cunningham Road, Bengaluru.

The complications that may arise are also less, which in turn will reduce anxiety among patients and reduce hospital stays. The procedure is especially beneficial for obese patients as it is less painful and cosmetically better. “RAKT offers a minimally invasive option resulting in smaller incisions, less pain, and faster recovery time that translates into shorter hospital stays and quicker return to daily activities with reduced risk of infections and surgical complications like hernia. This minimally invasive approach reduces the frequency of follow-ups, promoting patient comfort and reducing anxiety,” said Dr Vidyashankar P, lead consultant, nephrology, Aster CMI Hospital, Bengaluru.

“RAKT offers ease of doing surgery, better ergonomics, better vision, better dexterity to the surgeon; to the patient it offers minimal pain, cosmetic scar, less complications and similar to better renal functional outcomes. Obesity and morbid obesity are strong indications for robotic transplant. But we can still do RAKT in routine chronic kidney disease (CKD) patients as well,” said Dr Deepak.

Gaining popularity

According to experts, the maximum number of robotic kidney transplants happen in India, however, there is a need for standardisation to make it popular. “Standardisation of surgical technique and regular training of surgeons are needed. Sooner or later robotic kidney transplant will replace open kidney transplant in the future, provided the finance part is taken care of (the cost difference is Rs 1.5 lakh),” Dr Deepak said.

Response to the procedure has been good as the scar and pain associated with robotic kidney transplant is comparatively less than the conventional procedure. However, cost and availability of the facility remain the main deterrent, said Dr Manas Ranjan Pradhan, senior urologist and kidney transplant surgeon, at AMRI Hospitals, Bhubaneswar.

Cost and availability

“Like every other groundbreaking state-of-the-art technology, when robotics was incorporated the cost of the surgical procedure was prohibitively expensive. But with time and more companies introducing robots and competitive pricing, the cost has come down by a large extent”, Dr Shakir added. Insurance companies have also started to acknowledge and cover robotic surgeries, which allow more patients to benefit.
The surgical option is now available in metros and cities like Delhi, Mumbai, Chennai and Bengaluru, and costs around Rs 10-15 lakh.

“As more fascinating features are added to the robot with leaps in the field of AI and miniaturisation and with reducing costs of surgeries and surgical consumables, this is most definitely here to stay and is a blessing for every deserving patient suffering from the debilitating burden of renal failure,” Dr Shakir said.

Dr Vidyashankar also pointed out that though RAKT is becoming increasingly available in major Indian hospitals, it’s not yet as widespread as traditional surgery. “RAKT offers potential advantages especially for patients who might not be ideal candidates for open surgery due to obesity or complex anatomy. As with any surgery, there are certain risks like bleeding, infection, rejection of the donor’s kidney or leakage from the urinary tract which can be discussed with the surgeon before the procedure. However, it’s important to have a detailed discussion with your surgeon to determine the best approach,” he said, adding that the potential benefits of faster recovery and reduced hospital stay could offset some of these costs.

Loss of filtering ability

  • A kidney transplant is a surgery to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly

  • The main function of a kidney is to filter and remove waste, minerals and fluid from the blood by producing urine

  • When the filtering ability of kidneys deteriorate, harmful levels of fluid and waste accumulate in the body, which can raise blood pressure and result in kidney failure (end-stage renal disease)

  • End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally

  • People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive

Common causes of end-stage kidney disease

  • Polycystic kidney disease

  • Chronic, uncontrolled high blood pressure

  • Diabetes - Chronic glomerulonephritis — an inflammation and eventual scarring of the tiny filters within the kidneys

(With inputs from Hemant Kumar Raut @ Bhubaneswar)

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