The Department of Urology had achieved another milestone by performing the first Robot-assisted Kidney Transplantation on April 10, 2023. Robotic surgery in Kidney Transplantation offers many benefits like decreased chances of complications as compared to open surgery, safer and more efficacious for obese patients and all the benefits of minimal invasive surgery. The department is also performing robotic surgery regularly. A high level of expertise is required in both Kidney Transplantation and Robotic Surgery. RAKT is performed by transplant surgeons with extensive training and experience in robotics and transplant surgery. The department of urology has been performing robotic surgery since 2015. The experience in robotic surgery prompted the department to start robot-assisted renal transplantation to pass on the benefits of minimally invasive surgery to the transplant recipients, said Dr Uttam Mete, Professor and Head, Department of Urology.
The Renal transplantation has developed as a superior renal replacement therapy compared to established dialysis methods as it improves the quality of life maximally amongst patients with renal failure. Traditionally, kidney transplantation is carried out by open surgery by making large incisions. The length of the wound varies depending on surgeon & preference and the habits of the patient. In general, obese recipients require larger incisions. Larger wounds are associated with more wound related morbidity in terms of more pain, surgical site infection (SSI), delayed mobilization, significant time to return to daily activities , longer convalescence &; postoperative recovery, long-term complications such as incisional hernia and poor cosmesis. Transplant patients have additional risk factors for wound related complications related to the use of immunosuppressants.
To minimize wound related morbidity renal transplantation using a small incision can be performed using minimally invasive surgical procedures. Laparoscopic (LKT) and robotic assisted (RAKT) surgeries are the two commonly performed minimally invasive procedures. LKT has not been widely adopted, likely due to the challenges of performing vascular anastomosis with laparoscopic instruments and two-dimensional vision, causing loss of hand–eye coordination and the long instruments amplifying natural tremor and carrying a fulcrum effect, as well as poor ergonomics promoting surgeons fatigue compared to conventional open kidney transplant surgery. On the other hand a much smaller incision (about 7cm) is made in RAKT to insert the donor kidney into the abdomen and then to stitch the blood vessels and the ureter. Another four or five small (0.5 to 1cm) incisions are used to insert the instruments into the abdomen. One of the arms holds a high magnification 3D camera which is inserted into the abdomen through one of the key holes and provides a high- definition, magnified (12×), 3-D view of the surgical site. The other mechanical arms have surgical instruments attached to it that are designed to mimic the movement of the human hands and wrists. The surgeon uses the console of the computer to manipulate the small surgical instruments that are more flexible and manoeuvrable as compared to the human hand.