Living liver donors report an immense emotional and spiritual benefit from knowing they are saving the life of a loved one. However, it is impossible to overlook the surgical trauma, cosmetic scars and surgical risks to which otherwise healthy donors are exposed with this major operation. To mitigate the potential harm to donors, Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute has begun performing robotic living donor hepatectomies, one of only two programs in the United States to do so. The transplant team recently performed its 21st robotic living donor hepatectomy.
“The robot gives much better visualization and much better access to critical structures,” says Amar Gupta, MD, FRCS(C), an abdominal transplant and hepatopancreatobiliary surgeon on the medical staff at Baylor University Medical Center, part of Baylor Scott & White Health. “The camera can get into small areas that can be difficult to see even with an open procedure.
“Using the robot, four cuts less than 1 centimeter each and one 1-centimeter cut are made for a total of five small incisions,” Dr. Gupta continues. “In some cases, a 6- to 8- centimeter cut at the bikini line, similar to a C-section, is needed in order to remove the piece of liver. This results in an easier recovery and a lower risk of hernia.
The robotic platform has proven especially attractive to the transplant team due to the high resolution, static optics and the fine dexterous controls allowing for fine suturing and dissection of the portal structures and vena cava. Using a dual console setup and video recordings also allows an ideal and safe setting for surgical training in real time for such a high-risk operation and as a debriefing tool.
As with other robotic procedures, studies show there is better cosmesis with robotic hepatectomy and less pain than with an open procedure. Less pain translates into shorter hospital stays and a shorter time for the patient to return to work. The literature also shows there is less intraoperative blood loss with the robot than an open procedure.
“Robotic hepatectomy is extremely technically sensitive and demanding,” says Giuliano Testa, MD, MBA, FACS, chairman and chief of abdominal transplantation at Baylor Scott & White Simmons Transplant Institute. “Its complexity is demonstrated by the fact that it took us two full years from our first robotic liver surgery to performing a robotic living donor operation.”
Baylor University Medical Center at Dallas is a worldwide leader in robotic transplantation. No other program in the world offers robotic living donor hepatectomy, robotic living donor nephrectomy and robotic living donor hysterectomy. Transplant surgeons on the medical staff at Baylor Dallas were also the first team in Texas to perform a robotic kidney transplant.
“When we adopted the robotic platform, our intention from the very start was to ultimately utilize the system for living donor operations,” Dr. Testa says. “We believe the more you use this technology the better you get, which leads to wider applications within transplantation.”
Dr. Gupta adds, “The altruistic nature of live organ donation demands that we continue to seek better, safer, and less traumatic modalities for our donors. We know we are doing the right thing for a healthy person who doesn’t need surgery but is willing to put his or her body and life on the line for someone else.”
Learn more about robotic transplant at Baylor Scott & White Health.
