A decade ago laparoscopic technology revolutionized the field of surgery, creating a new generation of minimally invasive procedures. Today, surgeons at Saint Barnabas Health Care System have taken that technology one step further. They are using robotics to perform a number of operations, including living donor nephrectomies (kidney removal).
"Robot-assisted technology is a remarkable surgical tool. It's an advanced form of laparoscopic surgery that allows us to do precision work with less trauma to the patient," states Stuart Geffner, MD, Director of Transplant Surgery for the Saint Barnabas Health Care System. He is the first renal transplant surgeon in the region to perform robot-assisted living donor nephrectomies at both Saint Barnabas Medical Center in Livingston and Newark Beth Israel Medical Center in Newark.
How it Works
Utilizing the da Vinci Surgical System, the surgeon sits in a console a few feet from the patient and views the surgical site through a high-definition 3D viewer. A laparoscopic camera and robotic probes (arms) are inserted into the patient through four half-inch incisions. The surgeon uses hand controls and foot pedals to manipulate the robotic arms. These pencil-sized probes translate the surgeon's hand movements and adjust themselves to compensate for the natural tremor of the human hand. Dr. Geffner notes that the equipment can be set to make the tiniest movements with rock-steady precision.
The end of the robotic arm articulates 360 degrees, affording complete range of movement. "It gives us much greater dexterity and range of motion, more so than the human wrist," explains Dr. Geffner. "Therefore, when we remove a kidney we greatly reduce the amount of tissue damage." The donor kidney is removed fully intact through a small three-inch bikini line incision. Implantation of the donor kidney in the recipient still requires conventional surgery.
Benefit to the Donor
For the donor patient, robot-assisted surgery is safe, minimally invasive and offers faster recovery time. Patients usually leave the hospital within a day or two and resume normal activity shortly thereafter.
Dr. Geffner hopes that this new technology and the ease with which kidneys can be removed will encourage more people to become living donors. Nearly 75,000 people in the United States are waiting for a kidney transplant. Many have to wait three to five years before they find a match. A shortage of living donors is one reason for the long wait.
As Dr. Geffner concludes: "Robotics is a technology that will clearly evolve. It's only going to get better, for our patients as well."
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