On May 23, 2022, urologists Simon Bernardo and Pierre-Olivier Delbach, performed the first robotic-assisted laparoscopic kidney transplant using the DaVinci Xi surgical robot at Poitiers University Hospital. Dr. Bernardo has been practicing robotic donor kidney removal for several years now, but re-transplantation of a kidney via robotic surgery is a real technical feat.
Benefits of using the DaVinci Xi robot
There are many contraindications for kidney transplantation, such as obesity. Kidney transplantation via robotic surgery is a less invasive procedure than traditional surgery, which requires an incision of 15 to 25 centimeters. In fact, this technique leaves only four small scars of 0.5 to 5 cm (one for the insertion of the kidneys). It is a real asset both in terms of aesthetics and in terms of recovery. Robotic surgery reduces postoperative complications such as lymphocytosis and vascular complications, and promotes early rehabilitation by reducing postoperative pain in particular. The use of robotics in kidney transplantation could thus expand access to this healing solution. However, the lack of a robotic platform other than scheduled surgery at the University Hospital does not currently allow consideration of this technique outside of a live donation setting.
Importance of living donation for kidney transplant
The transplant allows you to live almost normally, when dialysis is heavy and restrictive. Today there is a shortage of follicles in France, and many patients are still undergoing dialysis due to the lack of available kidneys. Transplants by a living donor are insufficient to meet the needs, represent a minority of kidney transplants performed in France, and face many obstacles. Live donation is essential because the functional outcomes are much better in the long term than grafting from a deceased donor, and the grafts are highly compatible at the immune level, reducing the risk of rejection.
Experience and cooperation are essential
The robotic kidney transplant procedure is a new technology because it requires expertise in two areas: kidney transplantation and robotic surgery. The first surgical robot-assisted kidney transplant took place in 2002. The technology did not take off until 2015. Today it is still reserved for expert centers, as in Toulouse in particular, it is a team that pioneered this surgery, with a series published in 2021 of 29 patients.
Doctors Bernardo and Delbeck, urologists for several years at the University Hospital Poitiers, specialize in robotic surgery and kidney transplantation. For the surgeon, it is the same procedure as in open surgery but requires significant expertise in the two axes of this intervention. ” Robot arms are similar to the extension of a surgeon’s arms, but you need to understand that the installation /unbuckle Two meter long shipspatient objects m nnot instinctive !» Dr. Bernardo says. In addition to “The close and good cooperation between the Department of Urology and Nephrology is essential. Nephrologists have trusted us with this innovative technology.”. Achieving this first at the University Hospital of Poitiers was made possible thanks to the true collaborative work between the different departments, as well as between the medical and paramedical teams. ” Working with the elderlyAges of blocks are very important because they are gestures and actions trTechnical Would like to stress Dr. Bernardo. ” They also trained with IBODES teams in Toulouse ».
Today, doctors Bernardo and Delbeck are glad that the operation went well. Both patients, donor and recipient, are doing well. They now hope that this practice will become more democratic and that we will be able to expand the criteria for inclusion in the transplant, especially for obese patients.
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