University of Washington completes first U.S. robotic liver transplant

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University of Washington completes first U.S. robotic liver transplant

A surgical team from Washington University School of Medicine in St. Louis recently performed the first robotic liver transplant in the United States .

Successful transplant in May at Barnes-Jewish Hospital extends benefits of minimally invasive robotic surgery to liver transplants: smaller incision, less pain, faster recovery, plus performing one of the most challenging abdominal procedures the required precision.

University of Washington completes first U.S. robotic liver transplant

A surgical team from Washington University School of Medicine in St. Louis recently performed the first robotic liver transplant in the United States .

The patient, a man in his 60s who required a transplant for liver cancer and cirrhosis caused by the hepatitis C virus, is doing well and has returned to normal daily activities. Generally, liver transplant recipients need at least six weeks to walk without discomfort. One month after the operation, the patient not only walked freely, but also regained the ability to play golf and swim.

“The transplant was a success: the operation went well, the new liver started working immediately, and the patient recovered without any surgical complications,” said transplant surgeon Adeel Khan, MD, who led the team that performed the groundbreaking procedure people. Khan is an associate professor of surgery in the School of Medicine. “Liver transplantation is one of the most complex abdominal procedures and relies heavily on a dedicated team to achieve a good outcome. At Washington University and Barneys Jewish Hospital, we have been extremely fortunate to have the support we need to develop We have built a world-class robotic transplant team, allowing us to safely perform complex procedures. This team has been an important part of our success.”

A liver transplant is traditionally an “open” procedure in which the surgeon makes a 3- to 4-inch vertical incision and a 12- to 16-inch horizontal incision just below the chest cavity to remove the patient’s diseased liver and place a healthy donor liver.

Transplant surgeons have been pushing for less invasive procedures — smaller incisions, often resulting in less pain and faster recovery.

However, most transplants are considered too complex for minimally invasive methods—whether laparoscopic or robotic—and liver transplants are especially challenging.

Diseased livers tend to bleed profusely during surgery, and connecting the new liver to the patient’s circulatory system requires delicate stitching of several tiny blood vessels together.

Robotic surgery is a minimally invasive procedure. The surgeon takes full control of the robot’s tools and operates the surgery remotely — often just a few feet away from the patient — using joystick-like controls.

A high-resolution camera zooms in on a 3D view of the surgical site through a large monitor. This high-tech instrument can achieve very precise and delicate operations that cannot be achieved with traditional technology.

For this robotic liver transplant, surgeons operate through several half-inch keyhole incisions and a 6-inch vertical incision between the abdominal muscles to remove the diseased organ and place a new liver about the size of a football. into the abdomen.

The incision is much smaller than traditional incisions and does not require cutting through the abdominal muscles, allowing for faster recovery.

While the patient’s physical recovery has proceeded as planned, he did require some time in the hospital due to cognitive symptoms, which is not uncommon in elderly patients following major surgery.

The robotic liver transplant took just over eight hours — which is high-end, but within the expected time frame of a traditional open liver transplant, which typically takes six to eight hours.

Robotic liver transplants in the future could be done more quickly as operating room teams gain experience and become more attuned to the subtleties of the new surgical technique, Khan said.

A research team in South Korea reported the world’s first robotic liver transplant in 2021. The procedure, in which half a liver is transplanted from a living donor, rather than an entire organ, is performed partially robotically; the diseased liver is removed laparoscopically and a new liver is implanted robotically.

Khan said his team is the first robotic liver transplant to perform a whole liver transplant.

“Liver transplantation is the most difficult minimally invasive procedure to consider in an abdominal organ — given the difficulty of removing a failing liver and successfully implanting a new organ — but Dr. Khan has demonstrated that it is possible,” said William Chapman, MD Said, he is the Eugene M. Brick Professor of Surgery, Director of General Surgery and Director of Transplant Surgery at Washington University. “Further experience is needed to determine the extent of the benefit of liver transplantation as a minimally invasive procedure.”

Washington University and Barnes-Jewish Hospital have been focusing on robotic surgery as part of a joint effort to advance minimally invasive procedures and improve patient outcomes.

The robotic transplant team was founded five years ago and initially focused on kidney transplants.

To date, the team has performed more than 30 robotic kidney transplants, all with good results. The team also performs living nephrectomy procedures, as well as other robotic procedures involving the liver, bile ducts, pancreas and stomach.

“Over the course of several years, we have built a dedicated robotic transplant team that is second to none and has been instrumental to our success,” Khan said. “Once we had this team in place, it allowed us to increase the volume and complexity of our cases while maintaining very good patient outcomes. Transplant Services has five surgeons doing robotic surgery, and by the end of this summer, that number will That grew to seven. Since our program began, we have directed over 30 transplant centers across the country to successfully set up their own robotics programs. Transplant teams from other centers come to observe our process, and we also visit theirs site, guiding them in developing their skills. We may be one of the few places in the country that has the support, the expertise and the team to take robotic transplant surgery to this level.”