First robotic liver transplant in the United States performed by Washington University surgeons – Washington University School of Medicine in St. Louis

A surgical team at Washington University School of Medicine in St. Louis recently performed the first robotic liver transplant in the United States. The successful transplant at Barnes-Jewish Hospital in May extends the benefits of minimally invasive robotic surgery to liver transplants. The incision reduces pain, speeds recovery, and provides the precision needed to perform one of the most difficult abdominal surgeries.

The patient was a man in his 60s who needed a transplant due to liver cancer and cirrhosis caused by the hepatitis C virus, and his progress was good and he has returned to a normal daily life. Usually, it takes a patient who has received a liver transplant at least six weeks to be able to walk without discomfort. The patient was able to walk comfortably 6 weeks after surgery, and he was allowed to resume golf and swimming 7 weeks after surgery.

“The transplant was a success. The surgery went smoothly, the new liver started functioning immediately, and the patient recovered without any complications,” the transplant surgeon said. Dr. Adeel Khan, leader of the team that performed the pioneering surgery. Khan is an associate professor of surgery in the School of Medicine. “Liver transplantation is one of the most complex abdominal surgeries and relies heavily on a specialized team to achieve successful results. Here at the University of Washington and Barnes-Jewish Hospital, we have world-class facilities to safely perform complex surgeries. We are very fortunate to have the support we need to develop our robotic transplantation team, which is a huge part of our success.”

Liver transplants are traditionally performed as an “open” surgery, in which a surgeon makes a 3- to 4-inch vertical and 12- to 16-inch horizontal incision just below the rib cage to remove the patient’s diseased liver and remove the donated healthy liver. transplant a liver. liver. Transplant surgeons have called for the procedure to become less invasive. Smaller incisions usually result in less pain and faster recovery. However, most transplant surgeonshas been considered Liver transplantation is particularly difficult because it is too complex for minimally invasive approaches, whether done laparoscopically or robotically. Diseased livers tend to bleed excessively during removal surgery, and several small blood vessels must be carefully stitched together to attach the new liver to the patient’s circulatory system.

Robotic surgery is a type of minimally invasive surgery. The surgeon has full control of the robot’s tools and uses joystick-like controls to perform the surgery at a remote location, typically just a few feet away from the patient. A high-resolution camera provides a magnified 3D view of the surgical site, which can be viewed on a large monitor. High-tech equipment allows extremely precise and detailed operations that were not possible with traditional technology.

In this robotic liver transplant, surgeons make several 0.5-inch keyhole incisions and one 6-inch vertical incision between the abdominal muscles to remove the diseased organ, inside which is placed the size of a soccer ball. A new liver was installed. abdomen. This incision is much smaller than previously used incisions and does not require cutting into the abdominal muscles, allowing for a faster recovery.

Although the patient’s physical recovery is progressing as planned, cognitive symptoms, which are not uncommon in elderly patients after major surgery, required extra time in the hospital.

The robotic liver transplant took just over 8 hours, which was within the range of time expected for traditional open liver transplants, which typically take 6 to 8 hours. Kahn said future robotic liver transplants are likely to be completed more quickly as surgical teams gain experience and become familiar with the subtleties of new surgical techniques.

A South Korean team reported the world’s first robotic liver transplant in 2021. The surgery involved transplanting half a liver from a living donor rather than the entire liver, and part of the procedure was performed robotically. The diseased liver was removed laparoscopically and a new liver was implanted robotically. Khan said his team performed the first robotic liver transplant, which involves transplanting the entire liver.

“Liver transplantation is the most difficult abdominal organ to consider as a minimally invasive approach, given the difficulty in removing a failing liver and successfully transplanting a new organ, but Dr. Khan said this is possible. We have shown that there is.” Dr. William Chapman, Eugene M. Bricker Professor of Surgery, Chair of the Department of General Surgery and Chief of the Division of Transplant Surgery, University of Washington. “Further experience with this technique is needed to establish the extent of the benefit of using liver transplantation as a minimally invasive approach.”

The University of Washington and Barnes-Jewish Hospital are focusing on robotic surgery as part of a joint effort to advance minimally invasive surgery and improve patient outcomes. The robotic transplant team was formed five years before him and initially focused on kidney transplants. To date, the team has performed more than 30 robotic kidney transplants, all with positive results. The team also performs living donor kidney removal surgeries and other robotic surgeries on the liver, bile ducts, pancreas and stomach.

“Over the years, we have built a dedicated robotic transplant team that is second to none and has contributed to our success,” said Kahn. “Since installing this team, we have been able to increase both case volume and complexity while maintaining very good patient outcomes. Our transplant service, which performs robotic surgery, has five surgeons. By the end of the summer, this number will increase to seven. Since starting our program, we have mentored more than 30 transplant centers across the country to build their own robotics programs. Transplant teams from other centers come to observe our process. We also visit their facilities and provide guidance to improve their skills. We are probably one of the few facilities in the country that has the support, expertise and team to take robotic transplant surgery to this level.”