The First Robotic-Assisted
Donor Nephrectomy
January / February 2004
Penn transplant surgeons recently performed the first robotically-assisted
nephrectomy for kidney transplant in the Philadelphia region.
During the last four years, the Penn team has performed over
200 living donor nephrectomies using a minimally invasive
laparoscopic approach. This avoids the more morbid “open”
technique involving an incision through all of the flank
muscles.
Penn's transplant team considers the robot-assisted
technique the next important advance in the evolution of minimally
invasive donor nephrectomy surgery. Utilizing Intuitive Surgical's
da Vinci ™ Surgical System, the transplant surgeon sits
beside the patient at a computer terminal and views a 3-D
image of the surgical field. He or she uses special grips
to manipulate instrument handles that the computer translates
to the instruments inside the patient's body. This advanced
technology has several important benefits including increased
precision, less pain, less morbidity, shorter recovery and
a smaller incision.
“Standard lapaoroscopic instruments are straight. Robotic
instruments bend like your fingers and allow for greater precision
and greater visualization, which we think will add to the
safety of the procedure,” says James
Markmann, MD, PhD, associate professor of surgery and
transplant surgeon in the Penn Transplant
Center. “With
time, I anticipate that robotic technology will expand to
other areas of transplant and general surgery.”
Among transplant organs in the U.S., kidneys are in the
greatest demand. Penn has the largest kidney
transplant program in
the Delaware Valley with more than 200 cases per year. When
a patient requires a kidney transplant he or she is usually
placed on a waiting list to receive a cadaveric kidney or
a kidney from a living donor such as a family member or close
friend.
With wait times of up to six years for a cadaveric
kidney, the utilization of living donors has been steadily
rising. In fact, in 2001 there were approximately 6,000 living
kidney donors in the United States, which exceeded the number
of cadaveric donors for the first time. “Although live
donor nephrectomy is considered very safe, it is still a
major operation. As we perform more robotically-assisted
donor nephrectomys, I believe the number of living donors
will only continue to increase,” says Dr. Markmann.
According to a recent study that appeared in the New
England Journal of Medicine, researchers found that kidney transplant
provides patients with end-stage kidney disease a clear survival
benefit compared to patients who stay on dialysis. For many
patients, the life expectancy post transplant was more than
double that if they remained on dialysis. To be eligible for
a kidney donation the recipient must have end-stage renal
disease that cannot be reversed by another treatment method
or have another life-threatening condition such as cancer
or serious heart disease.
The latest report from the Scientific Registry of Transplant
Recipients confirms that high-volume, academic medical centers
have the best health outcomes for transplant procedures of
all kinds. The report, citing five years of accumulated data
from 1998, shows that the Hospital of the University of Pennsylvania
has the highest one-year survival rates among high-volume
facilities in the city for all major transplant procedures.
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Referring Physicians: To speak with a Penn physician
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referral form or by calling
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