Dec 7, 2021

Interviewer: When we're talking about a kidney transplantation, here at University of Utah Health, we have this robotic-assisted transplant surgery technology.

Dr. George Rofaiel is the guy behind the controls, one of them anyway. Tell us a little bit about robotic-assisted transplant surgery when we're talking about getting a kidney transplant. We're going to talk about both from not only the donor's perspective, but the recipient's perspective. Where would you like to start?

Dr. Rofaiel: I would like to start with donors actually.

Interviewer: So what would this procedure be like? Somebody has chosen that they would like to donate their kidney, that the time comes and it is time for you to take the kidney out so the recipient can get it. The traditional way would be an open surgery, but with a robotic-assisted transplant surgery, which has a lot of advantages, it might be a little different. People might not know what's going on. So talk me through that process.

Dr. Rofaiel: Sure. So there are actually a total of three general ways of doing kidney donation. One of them is the old-fashioned open way, and that is becoming rare actually. But the standard of care involves what we call hand-assisted laparoscopy, and that still involves a sizable incision around usually the umbilicus, around the belly button, and then laparoscopic trocars or laparoscopic incisions for the rest of the operation.

And the issues we have faced with this type of incision is a number of issues. Number one is cosmetic. It means the scar is in the middle of the abdomen, and that can be unsightly. Although many of our donors, of course, are doing this for great reasons and they don't care a whole lot. But nevertheless, they are usually young adults who would like to keep form and function.

Now, when it comes to function, it seems like the robotic-assisted operation, number one, hurts less. And number two, people seem to regain . . . the data is not quite there yet, but they seem to regain function a little faster.

And the reason for that, number one, is the way the technology works in terms of how the instruments move around the abdominal wall, or lack thereof, but also the location of the incision.

Robotics allows us to put the extraction incision somewhere where it doesn't hurt as much when we cough. It's much lower in the abdomen, it's far from site, and it's not in an area where it's visible.

But more than that, for patients who have the option of now what we call natural orifice extraction, meaning allowing us to take the kidney out without an incision at all, just robotic trocars, which are very, very small, literally poke holes, the robotics allows us to do this operation with a lot of ease. The machine moves in all quadrants of the abdomen and the control is exceptionally precise, which makes that latter part very, very safe.

Interviewer: So as a donor, you're able to move that incision into a place that's not quite so visible. It's not going to be nearly as large. I'd imagine there are other benefits too. Those smaller incisions are probably less vulnerable to infection. Would that be an accurate statement?

Dr. Rofaiel: I think it is. I think it's the location. I mean, of course, the size matters and the incisions are smaller, but when we put them on these alternative sites, we put them on sites where the abdominal pressure is not as high when people cough and move and so on. And I think it makes these incisions less vulnerable to, number one, pain, but number two, other complications like hernia formation, for example, wound infections, and so on. And then finally, and just as importantly, is the cosmetic advantage, of course.

Interviewer: And then another advantage to a donor is they can get back to work quicker. You can recover from this type of a robotic-assisted surgery a lot more quickly than the traditional open. Is that accurate? And what kind of timeframe are we talking about? Give us a comparison.

Dr. Rofaiel: It's not uncommon for our robotic-assisted surgery donors to go back to desk-type and computer-type jobs in the same week, in a matter of a couple days. Compare that to at least two to three weeks after hand-assisted laparoscopy, it's a big difference.

Interviewer: That's an incredible difference. I'd imagine a lot of people might like to donate a kidney and give the gift of life, but when you're talking about giving up a kidney and three or four weeks before you can get back to desk work, and if you're doing other type of labor, maybe even longer, that probably weighs into somebody's consideration.

Dr. Rofaiel: Oh, absolutely. I mean, these are usually younger working adults with families and responsibilities. And I will just give you an example. A donor not so long ago who lives far away . . . As you mentioned, we're in the Mountain West and our region is vast. They got most of their evaluation done remotely. They came for a very quick visit, they donated, they left the hospital the same day, and they left town two days later.

Interviewer: And the traditional method, that would not have been possible?

Dr. Rofaiel: Absolutely not.

Interviewer: Are there other benefits to the donors that you'd like to talk about when you're using the robotic-assisted transplant surgery?

Dr. Rofaiel: I think the biggest one is . . . Well, actually there are two items. One of them is the donors who can get this natural orifice extraction operation where there's no extraction site whatsoever. I mean, basically, number one, it hurts less. Number two, there is no incision to look at. Number three, the chances of forming a hernia and a wound infection essentially become eliminated. Never say zero, but for all intents and purposes, it is eliminated. And that's a huge functional advantage compared to even standard robotics and less so a hand-assisted laparoscopy.

For Patients