Historically, patients with a body mass index (BMI) over 40 have not been able to receive a kidney transplant due to increased risks, such as the surgeon’s inability to ensure successful placement of the kidney due to the extra girth, making it a poor performer. But robotic surgery may offer a solution.
Kidney transplants currently performed in heavier patients A deeper and larger incision is required to place the kidney. The increased distance between the blood vessels from the skin to the sutured kidneys is further from the surgeon’s hand, making open surgery more difficult than surgery on a non-obese abdomen. All of this puts morbidly obese people at a much higher risk of complications than non-obese people, said Dr. Thomas Pshak, a surgeon at the UCHealth Transplant Center and an expert in robotic kidney transplants.
Infection is also a big problem in morbidly obese patients because the incision is under the abdominal pannus, he added. As a result, the incision is difficult to heal and susceptible to infection because it is under this large skin fold and it is difficult to keep it dry.
Patients like these who do appear on transplant lists are often overlooked because of their risk factors, Pshak said.
Unlike open surgery, robotic kidney transplants can be safely performed on patients with a BMI over 40, according to Pshak, opening doors that were previously closed to such patients.As of February 8, UCHealth University of Colorado Hospital at the Anschutz Medical Campus performed Two successful robotic kidney transplants According to the press release, for patients with a BMI over 40. Pshak is the leader of the robotic kidney transplant team.
“We want to be able to give opportunity to anyone who is eligible for a transplant because we know they will live longer and have a better quality of life,” Pshak said. “The benefits of transplantation far outweigh the risks. So finding a way to transplant anyone who wants a transplant, regardless of their weight, is key information and gives hope to people who want a transplant that this can happen.”
With the robotic kidney transplant, a two-and-a-half-inch incision was made near the navel, three small incisions for the robotic arm and one for the camera. Robotic surgery is less invasive than open surgery (the current standard of care), which means patients usually don’t need anesthesia afterwards, Pshak said. In addition, the less invasive approach reduces the risk of postoperative wounds associated with open surgery. He added that on a three-year timeline, Robotic kidney transplant is as effective as open surgeryboth in terms of transplant efforts and patient survival, Pshak noted.
The procedure is effective for patients with a BMI of up to 60, adding access to larger patients, Pshak said.
However, UCHealth is only the fourth hospital to offer robotic kidney transplants. University of Illinois at Chicago, Cleveland Clinicand Henry Ford Hospital in Detroit Robotic surgery is also available.In fact, the Cleveland Clinic was the first Hospitals will do so in 2019.
UCHealth provides robotic surgery for patients west of the Mississippi River. Patients who had previously sought robotic kidney transplants had to travel east, which restricted access for many, Pshak said. UCHealth uses Intuitive Surgical’s Da Vinci robot Xi.
So if robotic kidney transplants work as well as open surgery and can be performed on a group of patients previously ineligible due to elevated BMI, why aren’t more hospitals and surgeons offering it? Learning how to use a robot has a steep learning curve, Pshak said. Surgeons adept at performing open surgery for kidney transplants often expressed reluctance to learn new methods, especially given the steep learning curve and fear that they might not be good at robotic transplants initially. Also, robotic surgery is not currently a requirement for residency or fellowship programs, so not all new surgeons have initial training, Pshak added.
“As we all know, there is a learning curve with robotics, even in simple situations. In kidney transplants, this is probably one of the more complex situations you can do because you’re closing major blood vessels with tiny sutures and you feel You don’t know what you’re doing, so a lot of transplants are based on how your hand feels and how tight you pull the sutures and how tight you feel. With the robot, you don’t,” Pshak said. “You rely on visual cues and experience to know how hard you can pull it before it tears. So there’s a huge learning curve and a big factor in why it hasn’t taken off yet.”
However, a new generation of surgeons may surpass the old surgeon: video games. Not only are some residential programs offering robot training, but more residents are playing video games than they were a few decades ago.
“A lot of young surgeons who have just been discharged now are being trained more and more in robotics,” Pshak said. “The younger generation is used to playing video games and doing more with robots. This could be the next thing that really takes off. waves.”
Photo: PhonlamaiPhoto, Getty Images
