In an exciting step forward in surgery advances, the first liver transplant performed by a robot has successfully taken place in the US, as clinics plan to ramp up wider use of this innovative procedure.
The man in his 60s, who required a critical transplant due to liver cancer and cirrhosis caused by hepatitis C, underwent surgery performed by the advanced machinery while the head surgeon controlled the robot’s movements from a console nearby.
“The transplant was a success: The operation went smoothly, the new liver started working right away, and the patient recovered without any surgical complications,” said transplant surgeon Dr Adeel Khan, who led the team of surgeons from Washington University School of Medicine in St Louis by at Barnes-Jewish Hospital.
The recipient was walking comfortably a month after the surgery and was looking to return to golf and swimming. Traditionally, it would take a patient around six weeks to be able to move without discomfort.
The hospital has been focused on developing this cutting-edge technology in order to minimize the invasiveness of surgery and in turn deliver much better recovery times and outcomes for patients. The surgeons have completed more than 30 kidney transplants, and other procedures involving bile ducts, the pancreas and stomach, using the robotics system, but this is their – and the nation’s – first liver transplant.
“Liver transplantation is one of the most complex abdominal operations and heavily relies on a specialized team for good outcomes,” said Dr Khan.
Traditionally, a surgeon would make a three- to four-inch (7.6 to 10-cm) vertical incision and 12- to 16-inch (30- to 41-cm) horizontal cut below the rib cage, in order to remove the diseased liver and replace it with the healthy donated organ. Because of the nature of the procedure, which can involve excessive bleeding and requires delicate sewing of small blood vessels, it had been thought to be too difficult to perform in a less invasive manner.
Robotic surgery is changing all of this. During this successful transplant, several half-inch (1.3-cm) keyhole incisions and a single six-inch (15-cm) vertical incision between the abdominal muscles were made, allowing for the liver to be removed. The surgeon, sitting at a screen nearby with joystick-like controllers, operated the robot’s tools. The screen, displaying the operation site in high-resolution 3D, allowed for more precise and intricate surgery than traditional methods.
The transplant took just over eight hours, but surgeons believe the time will shorten as the procedure becomes more commonplace in operating theaters.
“Liver transplantation is the most difficult of the abdominal organs to consider for a minimally invasive approach – given the difficulty of removing a failing liver and successfully implanting the new organ,” said Dr William Chapman, the director of Washington University’s Division of General Surgery. “Further experience with this technique will be needed to establish the extent of the benefits of performing liver transplant as a minimally invasive approach.”
Already, the da Vinci Surgery Systems are changing the face of how medical staff operate. With training and the rollout of the technology across the country, it’s expected many more patients will soon be going under the robot surgeon’s knife.
“We have five surgeons on the transplant service doing robotic surgery, and this number will increase to seven by the end of the summer,” Khan said. “Since starting our program, we have mentored over 30 transplant centers around the country in building successful robotic programs of their own. Transplant teams from other centers come to observe our process, and we also visit their sites and mentor them as they develop their skills.”
Not surprisingly, the potential of artificial intelligence to operate the machinery is being explored and may be the next frontier in robotic surgery advances.
Source: Washington University School of Medicine in St. Louis
