World’s first reported case of Robotic En-Bloc Kidney Transplant conducted at Fortis Bannerghatta

New Delhi: Fortis Hospital Bannerghatta Road achieved yet another clinical milestone by successfully conducting the world’s first reported case of Robotic En-Bloc Kidney Transplant.

In this, pioneering procedure, both the kidneys of a 13-month old deceased donor weighing 7.3 kgs were transplanted into a 30-year-old recipient weighing 50 kgs. This surgery marks a remarkable advancement in the field of kidney transplantation in the Indian context and brings new hope to patients with end-stage renal disease on chronic dialysis.

A multi-disciplinary team of doctors from Urology, Nephrology & Anesthesiology departments successfully conducted the transplant on 8th May, 2023.

The 30-year-old man was a known case of chronic renal failure on haemodialysis and was admitted to Fortis Bannerghatta with uncontrolled hypertension and anemia. His health was deteriorating and he needed urgent renal transplant surgery. It was then the kidneys from a 13-month-old donor who died of choking weighing 7.3 kgs were offered for transplantation. The recipient was listed with Jeevasarthakathe in Karnataka, and had been allotted the kidneys as per the norms. The highly skilled multidisciplinary team of doctors led by Dr. Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant, and Robotic Surgery at Fortis Hospitals Bengaluru performed the retrieval and transplant procedures simultaneously in parallel operating theatres, effectively simulating living donor kidney transplantation surgery. The entire procedure lasted approximately four hours, showcasing the team’s expertise and precision.

Dr Sreeharsha Harinatha, Additional Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant and Robotic Surgery, Fortis Hospital, Bannerghatta Road, stated “En-Bloc kidney transplantation is a complex procedure that entails transplanting both kidneys from a pediatric donor along with the vena cava and aorta into a single recipient. This innovative technique allows the transplanted kidneys to proportionately increase in size appropriate to the body weight of the recipient, resulting in nephron mass that have never been affected by the disease that caused the initial renal failure. Over time, the function of these transplanted kidneys improves thus providing long-term life enhancing benefits for the recipient.”

Dr. Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant, and Robotic Surgery at Fortis Hospitals, Bengaluru explained the surgical details, stating, “This critical transplant was the first of its kind as the donor weight measuring 7.3 kilograms, slightly exceeds the established cutoff weight of 7 kilograms. The patient underwent En-Bloc kidney transplant surgery using robot enhanced laparoscopic technique. The surgery was performed under general anaesthesia with strict asepsis protocol to prevent infections. Da Vinci Xi Robotic platform was deployed after laparoscopic ports were placed with pneumoperitoneum (presence of air or gas in the abdominal cavity).”

Dr Mohan added further: “The robotic system was positioned to accurately locate the blood vessels in the pelvic area. The donor’s kidneys were then removed as a part of multi organ retrieval through a midline incision. The kidneys underwent Bench surgery (surgery in which kidneys are removed from the patient’s body, repaired at a site outside the operating room, and implanted back into the body) in preparation for transplant. The kidneys were dropped into the recipient’s abdomen though a special device called Dextrus. The surgery successfully connected the donor’s blood vessels to the recipient’s arteries and veins. The ureters of the transplanted kidney were connected to the recipient’s bladder using reimplantation technique using the excellent magnification and dexterity of the robotic system.”

Post the surgery, the patient received comprehensive care in the Surgical Intensive Care Unit. Anaemia was managed by administering irradiated packed red blood cells, and immunosuppressive medications (Tacrolimus, Mycophenolate, and steroids) were used to prevent rejection of the transplanted kidney. The patient was discharged 12 days post-surgery with normal creatinine.