Washington College surgeons pioneer robotic liver transplantation


A surgical workforce from Washington College Faculty of Medication in St. Louis not too long ago carried out the primary robotic liver transplant within the U.S. in Might at Barnes-Jewish Hospital.

A surgical workforce from Washington College Faculty of Medication in St. Louis not too long ago carried out the primary robotic liver transplant within the U.S. The profitable transplant, achieved in Might at Barnes-Jewish Hospital, extends to liver transplants some great benefits of minimally invasive robotic surgical procedure: a smaller incision leading to much less ache and sooner recoveries, plus the precision wanted to carry out one of the crucial difficult belly procedures.

The affected person, a person in his 60s who wanted a transplant due to liver most cancers and cirrhosis attributable to hepatitis C virus, is doing effectively and has resumed regular, day by day actions. Sometimes, liver transplant recipients require not less than six weeks earlier than they will stroll with none discomfort. The affected person was not solely strolling simply one month after surgical procedure but additionally cleared to renew {golfing} and swimming.

“The transplant was successful: The operation went easily, the brand new liver began working immediately, and the affected person recovered with none surgical issues,” mentioned transplant surgeon Adeel Khan, MD, the chief of the workforce that carried out the trailblazing surgical procedure. Khan is an affiliate professor of surgical procedure on the Faculty of Medication. “Liver transplantation is likely one of the most advanced belly operations and closely depends on a specialised workforce for good outcomes. Right here at Washington College and Barnes-Jewish Hospital, we’re very lucky to have the assist wanted to develop a world-class robotic-transplant workforce that enables us to soundly carry out advanced operations. This workforce is an enormous a part of our success.”

A liver transplant historically is carried out as an “open” process, with a surgeon making a 3- to 4-inch vertical and 12- to 16-inch horizontal incision slightly below the rib cage to take away a affected person’s diseased liver and place the wholesome donated liver. There was a push by transplant surgeons to shift the process to 1 that’s minimally invasive – with smaller incisions that usually lead to much less ache and sooner recoveries. But, most transplant surgeries have been regarded as too sophisticated for a minimally invasive strategy – whether or not carried out laparoscopically or robotically — and liver transplants are significantly difficult. Diseased livers are susceptible to extreme bleeding throughout surgical procedure to take away them, and attaching the brand new liver to the affected person’s circulatory system requires delicately stitching a number of tiny blood vessels collectively.

Robotic surgical procedures are a type of minimally invasive surgical procedure. Surgeons preserve full management of the robotic’s instruments and carry out the operations remotely — often just some ft away from the affected person — utilizing joystick-like controls. Excessive-resolution cameras present a magnified, 3D view of the surgical web site viewable through a big monitor. The high-tech instrumentation permits for very exact, fantastic manipulations that might be unimaginable utilizing conventional methods.

For this robotic liver transplant, the surgeons operated by means of a number of half-inch keyhole incisions and made a single 6-inch vertical incision between the belly muscular tissues for eradicating the diseased organ and putting the brand new liver, which is concerning the dimension of a soccer, contained in the stomach. This incision is significantly smaller than the one used historically and doesn’t require reducing by means of belly muscular tissues, enabling a sooner restoration.

Whereas the affected person’s bodily restoration has been on schedule, he did require additional time within the hospital as a result of cognitive signs that aren’t uncommon in older sufferers after main surgical procedure.

The robotic liver transplant took simply over eight hours — on the excessive finish however inside the anticipated time-frame for conventional open liver transplants, which often take six to eight hours. Future robotic liver transplants probably will probably be accomplished sooner because the OR workforce features expertise and will get extra used to the subtleties of the brand new surgical method, Khan mentioned.

A South Korean workforce reported the primary robotic liver transplant on the earth in 2021. That surgical procedure concerned transplanting half a liver from a dwelling donor as an alternative of the entire organ, and the surgical procedure was partially robotic; the diseased liver was eliminated laparoscopically and the brand new liver implanted robotically. Khan mentioned his workforce is the primary to carry out a robotic liver transplant by which an entire liver was transplanted.

“Liver transplantation is probably the most tough of the belly organs to think about for a minimally invasive strategy — given the problem of eradicating a failing liver and efficiently implanting the brand new organ — however Dr. Khan has proven that that is doable,” mentioned William Chapman, MD, the Eugene M. Bricker Professor of Surgical procedure, director of Washington College’s Division of Normal Surgical procedure and chief of the transplant surgical procedure part. “Additional expertise with this method will probably be wanted to determine the extent of the advantages of performing liver transplant as a minimally invasive strategy.”

Washington College and Barnes-Jewish Hospital have centered closely on robotic surgical procedure as a part of a concerted effort to advance minimally invasive surgical procedures and enhance affected person outcomes. The robotic transplant workforce was shaped 5 years in the past, with an preliminary concentrate on kidney transplants. Up to now, the workforce has carried out greater than 30 robotic kidney transplants, all with good outcomes. The workforce additionally performs living-donor kidney elimination surgical procedure, and different robotic surgical procedures involving the liver, bile ducts, pancreas and abdomen.

“Over the span of a number of years, we’ve constructed a devoted robotic transplant workforce that’s second to none and has been instrumental to our success,” Khan mentioned. “As soon as we had this workforce in place, it allowed us to develop in each quantity and complexity of the circumstances whereas sustaining superb affected person outcomes. We’ve got 5 surgeons on the transplant service doing robotic surgical procedure, and this quantity will improve to seven by the tip of the summer season. Since beginning our program, we’ve mentored over 30 transplant facilities across the nation in constructing profitable robotic applications of their very own. Transplant groups from different facilities come to watch our course of, and we additionally go to their websites and mentor them as they develop their expertise. We’re most likely one of many only a few locations within the nation that has the assist, experience and workforce to take robotic transplant surgical procedure to this degree.”


Washington College Faculty of Medication


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