At AGH, a robot helps in kidney donation

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Hoping to improve kidney donors' experience and maybe encourage others to donate, Allegheny General Hospital recently performed the region's first robotic-assisted kidney removal.

Hospital officials on Thursday said the minimally invasive technique allowed the living donor to go home within a day of having his kidney removed, roughly half the normal hospital stay for a donor after surgery.

"This is about making the experience a little better for the donor," said Dr. Kusum Tom, the AGH surgeon who did the procedure June 30 on a 66-year-old Butler man. "We hope this enhances their experience and is a positive sign for donation."

The announcement comes at a unique time in the ongoing competition between West Penn Allegheny Health System, which includes AGH, and the region's dominant hospital system, UPMC.

PG VIDEO: AGH & ROBOTICS

Not only was WPAHS recently acquired by Highmark insurance, setting off a heated war with UPMC, which now refuses to negotiate a new insurance deal with Highmark, but UPMC's own living donor kidney and liver programs were deactivated in early May because of a botched transplant.

It's not known when UPMC's programs will be restarted, which requires approval from the United Network for Organ Sharing. UPMC said it would not comment for this story.

WPAHS spokesman Dan Laurent said Thursday's announcement was "many, many months in the making." He insisted the announcement was simply natural timing in the wake of the first transplant last week and not pegged to try to take advantage of UPMC's program being deactivated.

But Dr. Tom said she does hope the story counter-balances the negative publicity she thinks organ donation has received because of UPMC's troubles -- not just for AGH, but for UPMC and the VA Pittsburgh Healthcare System hospital in Oakland, which also does transplants.

"With all the bad publicity about transplants recently, we're hoping this will be something positive and turn people in Western Pennsylvania to see that all the news about transplants is not bad," she said.

The technique uses Intuitive Surgical's da Vinci Surgical System, a device that cost the West Penn Allegheny Health System more than $1 million when they bought it for AGH four years ago to use in a variety of surgical areas, including hysterectomies and prostatectomies.

The potential use of the robotic system is exciting, said Dr. Gnoc Thai, director of AGH's center for abdominal transplantation.

"It's primarily done on surgeries in the pelvis area where your hands get in the way, But we think it has a lot of potential applications that haven't even been fully explored yet."

Eventually, Dr. Thai and fellow AGH surgeon Dr. Akhtar Khan, who assisted Dr. Tom on the June 30 procedure, will also learn how to use da Vinci.

The surgery Dr. Tom performed June 30 took about four hours. But, Dr. Khan said, as they all do more of the surgeries they'll get faster at it, as he did with laparoscopic surgeries, which is better for the patient, too.

When using da Vinci, the doctor sits at a console equipped with a viewer that shows the binocular, 3-D footage inside the donor's body. The surgeon has her own hand movements expressed through three pencil-sized probes inserted in the donor's body through small, half-inch incisions. The small robotic devices compensate for the natural tremors in the human hand, allowing finer movements.

The doctors said pain can be greatly reduced using da Vinci. Because the laparoscopic instruments do not pivot inside the body like the da Vinci instruments, laparascopic surgery requires much more manipulation outside the patients' body, which results in more after-surgery surface and muscular pain.

"When I saw the first surgery using it, I thought, 'Wow, this is like Buck Rogers,' " said Dr. Tom, who trained in the technique last month at both the University of Illinois at Chicago and Cleveland Clinic. "It's incredible as a surgeon to see your motions transmitted into these minute, fine movements."

The University of Illinois at Chicago was the first transplant center to use da Vinci to perform a living donor nephrectomy, or kidney removal, in 2000.

UIC has done more than 800 similar surgeries since, said Enrico Benedetti, UIC's chief of transplant surgery, "but I don't think you can claim it's superior to laparoscopic surgery. We prefer it because we believe we have better control of the anatomy with it."

Transplant surgeon Stuart Geffner agrees with Dr. Benedetti that there doesn't appear to be an advantage in outcomes between using da Vinci or laparoscopic techniques, making it the "surgeon's choice" which technique to use.

He uses the more long-standing laparoscopic technique for kidney removal, "But we've also done more than 20 minimally invasive transplants (putting a kidney into a patient) using the da Vinci."

"The future may very well be to implant a kidney using minimally invasive surgery" instead of "open" surgery, where a larger incision is made to put the kidney into a recipient, said Dr. Geffner, director of kidney and pancreas transplant surgery at Saint Barnabas Health Care System in Livingston, N.J.

Dr. Tom isn't sure AGH will ever use da Vinci for a transplant -- "Though you never say never," she said.

But, for now, AGH is happy with its first results using the machine.

After the June 30 surgery, the donor's kidney was flown to Columbia University Medical Center in New York, where it was successfully transplanted into a 65-year-old man with end-stage renal disease.

The altruistic donor -- he wasn't related or friends with any particular recipient -- began a much larger chain of matched kidney transplants organized across the country by the National Kidney Registry, a private organization. So far, four people have received kidneys in the chain, which is ongoing, AGH officials said.

The donor, who asked not to be named, said he'd been thinking about making the donation for years, and "I know that they don't like doing living donor surgeries after 70 -- and I'm 66."

The donor is feeling so well that he was traveling on a six-hour car trip to Canada with his family on Thursday.


Sean D. Hamill: shamill@post-gazette.com or 412-263-2579.


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