1st robotic transplant of full liver a success

ST. LOUIS — A surgical team from Washington University’s School of Medicine has successfully performed the first robot-assisted whole-liver transplant in the U.S. — and the patient was cleared to get back on the golf course just a month later.

The surgery took place in May at Barnes-Jewish Hospital, and the patient — a man in his 60s with liver cancer and cirrhosis due to a hepatitis C infection — has recovered swiftly, according to his doctors.

“We’re trying to maximize all of the technologies that we have to be safe and to do what’s best for the patients,” said Dr. Maria Majella Doyle, director of WUSM’s liver transplant program. “This is a huge innovation in liver transplants — something that really has not changed for many years.”

During robotic surgeries, a surgeon uses joystick-like controls to operate robotic arms equipped with surgical tools that allow for extremely precise movements. This takes place at a nearby console, while other medical professionals remain at the patient’s bedside.

Previous robotic liver transplants involved transplanting partial livers from living donors, or performing part of the surgery robotically and the rest traditionally. The robotic surgery team at WUSM, for example, has performed previous surgeries in which they removed the diseased liver robotically, then made a slightly bigger incision to implant the donated liver without the robot.

“This was the first time where we did both parts together,” said Dr. Adeel Khan, transplant surgeon and leader of the team that conducted the surgery.

The liver recipient was cleared to resume some exercise only a month after the procedure, when most patients recovering from an open liver transplant require double or triple that time before feeling well enough to undertake any physical activity.

A traditional liver transplant usually involves a surgeon making a large horizontal incision, between 12 and 16 inches, just beneath the rib cage, as well as a vertical incision that’s about 3-4 inches, Khan said. The extent to which the incision size can be reduced is limited by the size of the liver — the largest solid internal organ in the body.

The incision for this robotic surgery was along the patient’s midline and avoided cutting through any abdominal muscle. The surgeons involved said it was only about 6 to 7 inches long.