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Robotic Surgery in Organ Transplantation

  • Ivo Tzvetanov
  • Sandra Garcia Aroz
  • Mario Spaggiari
  • Enrico Benedetti
Chapter

Abstract

The application of minimally invasive surgical technologies has gained widespread adoption. The surgical robotic system has allowed surgeons to perform complex procedures, otherwise unachievable. Robotic systems afford access to minimally invasive surgery to more patients with a variety of pathological conditions. Better surgical dexterity and vision for surgeons, in addition to a facilitated learning curve, compared to conventional laparoscopic surgery, leads to lower rate of complications and higher patient satisfaction. Until recently, these benefits were inaccessible for patients in need of solid organ transplants. Conventional laparoscopy has been seen as non-applicable for such a technically demanding procedure. The introduction of the da Vinci Robotic Surgical System has expanded the ability to complete solid organ transplantation in a minimally invasive fashion. Robotic applications in kidney, pancreas, and liver transplantation have been reported. There are several groups which report their experiences and initial results showing the viability of this technique in the field. The biggest experience has been described in kidney transplantation. One of the main advantages of the robotic surgery is the significantly lower rate of surgical site infections, which in immunosuppressed patients is reflected in superior outcomes. Another proven advantage is that the robotic kidney approach permits transplantation in extreme BMI categories without additional technical complications. The first results in pancreas transplantation and living donor hepatectomies are very promising; however, larger series are needed in order to address the value of the robotic surgery in other areas of solid organ transplantation.

References

  1. 1.
    Flowers, J. L., Jacobs, S., Cho, E., Morton, A., Rosenberger, W. F., Evans, D., et al. (1997). Comparison of open and laparoscopic live donor nephrectomy. Annals of Surgery, 226(4), 483–489; discussion 9–90.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Harris, S. J., Arambula-Cosio, F., Mei, Q., Hibberd, R. D., Davies, B. L., Wickham, J. E., et al. (1997). The Probot – An active robot for prostate resection. Proceedings of the Institution of Mechanical Engineers. Part H, 211(4), 317–325.CrossRefGoogle Scholar
  3. 3.
    Sung, G. T., & Gill, I. S. (2001). Robotic laparoscopic surgery: A comparison of the DA Vinci and Zeus systems. Urology, 58(6), 893–898.CrossRefPubMedGoogle Scholar
  4. 4.
    Finley, D. S., & Nguyen, N. T. (2005). Surgical robotics. Current Surgery, 62(2), 262–272. doi: 10.1016/j.cursur.2004.11.005.CrossRefPubMedGoogle Scholar
  5. 5.
    Matas, A. J., Payne, W. D., Sutherland, D. E., Humar, A., Gruessner, R. W., Kandaswamy, R., et al. (2001). 2,500 living donor kidney transplants: a single-center experience. Annals of Surgery, 234(2), 149–164.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pugin, F., Bucher, P., & Morel, P. (2011). History of robotic surgery: From AESOP(R) and ZEUS(R) to da Vinci(R). Journal of Visceral Surgery, 148(5 Suppl), e3–e8. doi: 10.1016/j.jviscsurg.2011.04.007. CrossRefPubMedGoogle Scholar
  7. 7.
    Herron, D. M., Marohn, M., & Group S-MRSC. (2008). A consensus document on robotic surgery. Surgical Endoscopy, 22(2), 313–325.; discussion 1–2. doi: 10.1007/s00464-007-9727-5.CrossRefPubMedGoogle Scholar
  8. 8.
    Rosales, A., Salvador, J. T., Urdaneta, G., Patino, D., Montlleo, M., Esquena, S., et al. (2010). Laparoscopic kidney transplantation. European Urology, 57(1), 164–167. doi: 10.1016/j.eururo.2009.06.035.CrossRefPubMedGoogle Scholar
  9. 9.
    Schweitzer, E. J., Wilson, J., Jacobs, S., Machan, C. H., Philosophe, B., Farney, A., et al. (2000). Increased rates of donation with laparoscopic donor nephrectomy. Annals of Surgery, 232(3), 392–400.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Horgan, S., Benedetti, E., & Moser, F. (2004). Robotically assisted donor nephrectomy for kidney transplantation. American Journal of Surgery, 188(4A Suppl), 45S–51S. doi: 10.1016/j.amjsurg.2004.08.028.CrossRefPubMedGoogle Scholar
  11. 11.
    Horgan, S., Vanuno, D., Sileri, P., Cicalese, L., & Benedetti, E. (2002). Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation, 73(9), 1474–1479.CrossRefPubMedGoogle Scholar
  12. 12.
    Gorodner, V., Horgan, S., Galvani, C., Manzelli, A., Oberholzer, J., Sankary, H., et al. (2006). Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transplant International, 19(8), 636–640. doi: 10.1111/j.1432-2277.2006.00315.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Horgan S, Galvani C, Gorodner MV, Jacobsen GR, Moser F, Manzelli A, et al. (2007). Effect of robotic assistance on the “learning curve” for laparoscopic hand-assisted donor nephrectomy. Surgical Endoscopy and Other Interventional Techniques, 21(9), 1512–1517. doi: 10.1007/s00464-006-9140-5.CrossRefPubMedGoogle Scholar
  14. 14.
    Giacomoni, A., Di Sandro, S., Lauterio, A., Concone, G., Buscemi, V., Rossetti, O., et al. (2015). Robotic nephrectomy for living donation: surgical technique and literature systematic review. American Journal of Surgery. doi: 10.1016/j.amjsurg.2015.08.019. CrossRefPubMedGoogle Scholar
  15. 15.
    Hubert, J., Renoult, E., Mourey, E., Frimat, L., Cormier, L., & Kessler, M. (2007). Complete robotic-assistance during laparoscopic living donor nephrectomies: an evaluation of 38 procedures at a single site. International Journal of Urology, 14(11), 986–989. doi: 10.1111/j.1442-2042.2007.01876.x.CrossRefPubMedGoogle Scholar
  16. 16.
    Toledo-Pereyra, L. H., & Toledo, A. H. (2005). 1954. Journal of Investigative Surgery, 18(6), 285–290. doi: 10.1080/08941930500433860.CrossRefPubMedGoogle Scholar
  17. 17.
    OPTN.org. (2015). Donor, Kidney, by donor type. http://optn.transplant.hrsa.gov/converge/latestData/rptData.asp. Accessed July 2015.
  18. 18.
    Axelrod, D. A., McCullough, K. P., Brewer, E. D., Becker, B. N., Segev, D. L., & Rao, P. S. (2010). Kidney and pancreas transplantation in the United States, 1999-2008: The changing face of living donation. American Journal of Transplantation, 10(4 Pt 2), 987–1002. doi: 10.1111/j.1600-6143.2010.03022.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Ratner, L. E., Ciseck, L. J., Moore, R. G., Cigarroa, F. G., Kaufman, H. S., & Kavoussi, L. R. (1995). Laparoscopic live donor nephrectomy. Transplantation, 60(9), 1047–1049.PubMedGoogle Scholar
  20. 20.
    Matas, A. J., Bartlett, S. T., Leichtman, A. B., & Delmonico, F. L. (2003). Morbidity and mortality after living kidney donation, 1999-2001: Survey of United States transplant centers. American Journal of Transplantation, 3(7), 830–834.PubMedGoogle Scholar
  21. 21.
    Andersen, M. H., Mathisen, L., Oyen, O., Edwin, B., Digernes, R., Kvarstein, G., et al. (2006). Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: A randomized study. American Journal of Transplantation, 6(6), 1438–1443. doi: 10.1111/j.1600-6143.2006.01301.x.CrossRefPubMedGoogle Scholar
  22. 22.
    Galvani, C. A., Garza, U., Leeds, M., Kaul, A., Echeverria, A., Desai, C. S., et al. (2012). Single-incision robotic-assisted living donor nephrectomy: Case report and description of surgical technique. Transplant International, 25(8), e89–e92. doi: 10.1111/j.1432-2277.2012.01493.x.CrossRefPubMedGoogle Scholar
  23. 23.
    Oberholzer, J., Tzvetanov, I., Mele, A., & Benedetti, E. (2010). Laparoscopic and robotic donor pancreatectomy for living donor pancreas and pancreas-kidney transplantation. Journal of Hepato-Biliary-Pancreatic Sciences, 17(2), 97–100. doi: 10.1007/s00534-009-0146-y.CrossRefPubMedGoogle Scholar
  24. 24.
    Liu, X. S., Narins, H. W., Maley, W. R., Frank, A. M., & Lallas, C. D. (2012). Robotic-assistance does not enhance standard laparoscopic technique for right-sided donor nephrectomy. Journal of the Society of Laparoendscopic Surgeons., 16(2), 202–207.CrossRefGoogle Scholar
  25. 25.
    Doumerc, N., Beauval, J. B., Rostaing, L., & Sallusto, F. (2016). A new surgical area opened in renal transplantation: A pure robot-assisted approach for both living donor nephrectomy and kidney transplantation using transvaginal route. Transplant International, 29(1), 122–123. doi: 10.1111/tri.12678.CrossRefPubMedGoogle Scholar
  26. 26.
    Menon, M., Sood, A., Bhandari, M., Kher, V., Ghosh, P., Abaza, R., et al. (2014). Robotic kidney transplantation with regional hypothermia: A step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). European Urology, 65(5), 991–1000. doi: 10.1016/j.eururo.2013.12.006.CrossRefPubMedGoogle Scholar
  27. 27.
    Abaza, R., Ghani, K. R., Sood, A., Ahlawat, R., Kumar, R. K., Jeong, W., et al. (2014). Robotic kidney transplantation with intraoperative regional hypothermia. BJU International, 113(4), 679–681. doi: 10.1111/bju.12572.CrossRefPubMedGoogle Scholar
  28. 28.
    Oberholzer, J., Giulianotti, P., Danielson, K. K., Spaggiari, M., Bejarano-Pineda, L., Bianco, F., et al. (2013). Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. American Journal of Transplantation, 13(3), 721–728. doi: 10.1111/ajt.12078.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Menon, M., Abaza, R., Sood, A., Ahlawat, R., Ghani, K. R., Jeong, W., et al. (2014). Robotic kidney transplantation with regional hypothermia: Evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL phase 0 and 1). European Urology, 65(5), 1001–1009. doi: 10.1016/j.eururo.2013.11.011.CrossRefPubMedGoogle Scholar
  30. 30.
    Tsai, M. K., Lee, C. Y., Yang, C. Y., Yeh, C. C., RH, H., & Lai, H. S. (2014). Robot-assisted renal transplantation in the retroperitoneum. Transplant International, 27(5), 452–457. doi: 10.1111/tri.12279.CrossRefPubMedGoogle Scholar
  31. 31.
    Gordon, Z. N., Angell, J., & Abaza, R. (2014). Completely intracorporeal robotic renal autotransplantation. The Journal of Urology, 192(5), 1516–1522. doi: 10.1016/j.juro.2014.02.2589.CrossRefPubMedGoogle Scholar
  32. 32.
    Lee, J., & Ordon, M. (2016). Innovative applications of robotic surgery: Renal allograft and autologous transplantation. F1000Res, 5. doi: 10.12688/f1000research.7343.1.
  33. 33.
    Lee, J. Y., Alzahrani, T., & Ordon, M. (2015). Intra-corporeal robotic renal auto-transplantation. Canadian Urological Association Journal, 9(9–10), E748–E749. doi: 10.5489/cuaj.3015.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Troppmann, C., Gruessner, A. C., Dunn, D. L., Sutherland, D. E., & Gruessner, R. W. (1998). Surgical complications requiring early relaparotomy after pancreas transplantation: A multivariate risk factor and economic impact analysis of the cyclosporine era. Annals of Surgery, 227(2), 255–268.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Boggi, U., Signori, S., Vistoli, F., D'Imporzano, S., Amorese, G., Consani, G., et al. (2012). Laparoscopic robot-assisted pancreas transplantation: First world experience. Transplantation, 93(2), 201–206. doi: 10.1097/TP.0b013e318238daec.CrossRefPubMedGoogle Scholar
  36. 36.
    Buell, J. F., Cherqui, D., Geller, D. A., O'Rourke, N., Iannitti, D., Dagher, I., et al. (2009). The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Annals of Surgery, 250(5), 825–830.CrossRefPubMedGoogle Scholar
  37. 37.
    Giulianotti, P. C., Coratti, A., Sbrana, F., Addeo, P., Bianco, F. M., Buchs, N. C., et al. (2011). Robotic liver surgery: Results for 70 resections. Surgery, 149(1), 29–39. doi: 10.1016/j.surg.2010.04.002.CrossRefPubMedGoogle Scholar
  38. 38.
    Giulianotti, P. C., Tzvetanov, I., Jeon, H., Bianco, F., Spaggiari, M., Oberholzer, J., et al. (2012). Robot-assisted right lobe donor hepatectomy. Transplant International, 25(1), e5–e9. doi: 10.1111/j.1432-2277.2011.01373.x.CrossRefPubMedGoogle Scholar
  39. 39.
    Lai, E. C., Tang, C. N., & Li, M. K. (2012). Robot-assisted laparoscopic hemi-hepatectomy: Technique and surgical outcomes. International Journal of Surgery, 10(1), 11–15. doi: 10.1016/j.ijsu.2011.10.005.CrossRefPubMedGoogle Scholar
  40. 40.
    Soubrane, O., Cherqui, D., Scatton, O., Stenard, F., Bernard, D., Branchereau, S., et al. (2006). Laparoscopic left lateral sectionectomy in living donors: Safety and reproducibility of the technique in a single center. Annals of Surgery, 244(5), 815–820. doi: 10.1097/01.sla.0000218059.31231.b6.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Koffron, A. J., Kung, R., Baker, T., Fryer, J., Clark, L., & Abecassis, M. (2006). Laparoscopic-assisted right lobe donor hepatectomy. American Journal of Transplantation, 6(10), 2522–2525. doi: 10.1111/j.1600-6143.2006.01498.x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • Ivo Tzvetanov
    • 1
  • Sandra Garcia Aroz
    • 1
  • Mario Spaggiari
    • 1
  • Enrico Benedetti
    • 1
  1. 1.Division of Transplantation, Department of SurgeryUniversity of Illinois at ChicagoChicagoUSA

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