MUSC Health surgeons celebrate living kidney donation performed robotically

 

MUSC Health has built a large and successful living kidney donor program. But the surgeons in the program aren’t content to keep doing things the way they’ve done them for years.

So, on Sept. 1, surgeons Vinayak Rohan, M.D., and Satish Nadig, M.D., D.Phil., used robotic surgery to remove a living donor’s kidney, becoming one of the first programs in the Southeast to perform this surgery robotically.

Unlike traditional surgery, in which the surgeon stands over the patient to operate, or even laparoscopic surgery, which minimizes incisions but is also performed at the operating table, robotic surgery means the surgeon is sitting at a console across the room. Using joysticks, the surgeon controls cameras that give a 3D view within the patient’s body and mechanical arms that perform the surgery through tiny incisions.

But with the current success of the program using laparoscopic surgery, why change? Rohan said surgery is a field that is ever-evolving. The advanced imaging of the DaVinci robotic system enables surgeons to be more precise in their movements, he said.

More importantly, the robotic system gives surgeons easier access to areas that are hard to reach. That means better ergonomics for the surgeon, who no longer has to contort and strain to reach the correct area, Rohan said.

“So many operations, which were previously done laparoscopically, with excellent results, are now done with robotics because suddenly you realize, ‘Oh, there's a more efficient way to do this and still get excellent results for the patient,’” Rohan said.

Better ergonomics for the surgeon benefits the patients, too. Betts Bishop, R.N., DaVinci coordinator for MUSC Health, said MUSC Health surgeons take on cases that require an extra level of care.

“We get a very complex caseload at MUSC,” she said. “We do have some more challenging cases.”

 

The minimally invasive nature of the surgery usually means easier recoveries than traditional open surgeries, and the robotic arms mean that surgeons can reach deeper or higher into the body than they otherwise could, she said.

In the case of living donor robotic surgery, because the kidney has to be removed so that it is still usable, surgeons have to make a larger incision than they normally would in minimally invasive surgeries. Nonetheless, in the case performed Sept. 1, the donor patient was well enough to be discharged the following day.

Bishop said the robotic system is used by about a dozen specialties, ranging from heart care to urology.

But surgeons don’t make the switch overnight. Even the most experienced of surgeons must undergo complete training on the system, including operating on models and then under the supervision of a proctor, before they can begin scheduling cases. The nurses, too, undergo training on the system.

For kidney removal, or nephrectomy, Rohan foresees his cases being about half-and-half robotic and laparoscopic, depending on the availability of robotic systems. That balance will probably shift more toward robotic as the hospital system acquires more machines, he said.

Rohan is also looking ahead to the next milestone – performing a transplant robotically. Transplanting a kidney is significantly more intricate than removing one, and few programs are performing this operation robotically, he said. But Rohan is eager to constantly advance what MUSC Health can offer to patients.

“It's going to be exciting. We achieved this, and it’s going to be great for our patients,” he said.