COMMENTARY

Robots Lend a Hand in Kidney Transplantation

Ron Shapiro, MD

Disclosures

August 11, 2010

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Hi, my name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh, and today I want to talk to you about a single case report that I found to be exceptionally interesting, even if I'm not certain about its long-term clinical applicability.

This was a report of the use of a robot to assist in the performance of a kidney transplant operation in a recipient -- in this case, a morbidly obese recipient. The transplant was successful and was performed uneventfully, and the robot was used to anastomose the renal vein, the renal artery, and the ureter. A relatively small incision was used for the recipient. This kidney was placed intraperitoneally, and the patient did quite well with no evidence of wound infection, and with a relatively stable postoperative course.

The authors go on to discuss the potential advantages of robotic assisted kidney transplantation. It's an interesting case report, I think. One wonders if it is really necessary to use a $3 million machine to perform an operation that is, actually, relatively straightforward and has been performed thousands and thousands of times in a conventional way with relatively little postoperative pain. Retroperitoneal exposure in general is not an operation that is associated with a great deal of pain.

However, it is important to look at all sorts of possibilities, and this may well become a standard in the future, although I'm not certain that it will be. Not all operations where the robot can be used are necessarily operations where the robot represents a major advance. Certainly, in the performance of radical prostatectomy, both open and robotic-assisted radical prostatectomy are successful procedures, but it is not clear that the robot was, as represented, a revolution.

Certainly, in the case of perhaps morbidly obese recipients where a large incision would be used, there may be a role for the robot. This certainly is an interesting idea. It remains to be seen whether this very interesting contribution will be one that will go on to be utilized in the majority of kidney transplant recipients in the United States and around the world.

Thank you.

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