10 February 2017
The Royal Free has become one of the first hospitals in the country to carry out a kidney transplant with the help of a surgical robot.
Two patients received kidney transplants at the end of last year with the help of the Da Vinci Xi robot – a £2 million surgical robot which until now has been used for kidney cancer surgery at the Royal Free Hospital.
Robotic surgery consultant, Ravi Barod and consultant transplant surgeon Neal Banga have been working together for the past six months to enable this new type of surgery to take place at the Royal Free Hospital for the first time. Scroll down to view our film about the surgery.
Robotic surgery allows the donated kidney to be transplanted into the recipient patient using keyhole surgery. This means that the patient has a much smaller wound compared to a traditional open kidney transplant, with a lower risk of wound complications, such as infection which is a particular risk for transplant patients as they take immune-suppressing medication after their operation.
In the future, the surgeons hope that this technique can be used for overweight patients who would not otherwise have been suitable for an open kidney transplant.
Earlier this year Neal, Ravi and Angeline Shoniwa, a senior theatres nurse, travelled to India to train with a world expert in this field, Dr Rajesh Ahlawat.
Ravi said: “In India we met Dr Ahlawat and observed four transplants to ensure we knew what to expect. We also carried out some additional training with the robot in Belgium. Our approach has been to have a robotic urology surgery expert alongside a transplant surgery expert – Neal and I did the surgery together – we have always had a joint approach which has been shown to be the most successful way of starting this kind of surgery.
“A technical advantage is that the robotic instruments have a greater range of movement than the human hand, which allows us to perform the operation with more accuracy. The robot allows you to put the kidney in using smaller incisions, which means less blood loss, less pain, and a smaller wound, so it is less likely to become infected. All this means that the patient is likely to make a quicker recovery and return to regular activities.”
Dr Ahlawat was present during the two operations and was able to offer advice if necessary during the two procedures.
Neal, who has been a consultant transplant surgeon for five years, said: “I am really pleased with how the operations have gone and I’m proud of what the team has achieved. Everyone worked together to get this right for our patients – the surgeons, the nurses and the anaesthetists. I am very excited about the programme going forward - not just to improve the experience of patients but to also offer patients who would not otherwise be able to have surgery the chance of having a life-changing kidney transplant. We hope to carry out 10-15 robot-assisted transplants this year.”
Vick Patel and Angelika Jakowlew were the two patients undergoing the kidney transplants – they both received a kidney from a family member. The donor operation is routinely performed using keyhole surgery, but using keyhole surgery for the recipient operation is a new surgical technique that has only emerged in the last few years.
Vick Patel, 46, from north London, said the robot-assisted operation meant the recovery time was much shorter than he had initially expected.
“The confidence I had in Neal Banga and Dr Ahlawat definitely made it less stressful for me,” said Mr Patel. “Because the actual cut is smaller, I am recovering more quickly and I didn’t need as many pain killers. I just needed some paracetamol for the first few days after the operation.”
Doctors first noted that Mr Patel’s kidneys weren’t 100% when he went for his regular check up. “The tests revealed that my kidneys were working well below the level they should be,” he said. “I was then referred to a specialist who prescribed medication. However, last year functionality went down again to 12%. This meant that if I hadn’t had a transplant I would have needed dialysis.”
Various members of his family were tested for their suitability for organ donation and it emerged that his wife, Sima, was the best match. With both of their parents undergoing an operation, it was difficult time for the couple’s two daughters, aged nine and 10. They were cared for by Mr Patel’s sister-in-law during the operation and are relieved that the couple are now both making a good recovery.
Mr Patel added: “I was happy to be one of the first robot-assisted transplant patients in the country. Not only because everything went smoothly, but because I feel this new procedure contributed to a much faster recovery, so I’m really pleased to have been involved.”
Angelika needed a transplant after suffering kidney failure which had gradually become worse over the past 12 years. Her mother Grazyna, who lives in Italy, was an excellent match for her and flew over the UK to donate a kidney.
Angelika, 38, said she was delighted to be one of the first patients to have this type of surgery at the Royal Free Hospital. “It’s a privilege to be part of this,” she said. “The doctors explained all the benefits and the risks and I also did a bit of research myself. It seemed like there were lots of benefits – especially going back to work more quickly. They always said they could revert to ordinary surgery if necessary so it seemed like an obvious choice. Following the operation I am feeling really well – so far so good!”
Images: Top (L-R) Ravi Barod, Angeline Shoniwa, Vick Patel, Angelika Jakowlew and Neal Banga, and bottom L-R Sam Aleebux, Ravi Barod, Pedro Silva, Neal Banga and Tana Tanabalan with the Da Vinci Xi surgical robot.
Notes to editors
About the Royal Free London NHS Foundation Trust
The Royal Free began as a pioneering organisation and continues to play a leading role in the care of patients. Our mission is to provide world class expertise and local care. In the 21st century, the Royal Free London continues to lead improvements in healthcare.
The Royal Free London attracts patients from across the country and beyond to its specialist services in liver and kidney transplantation, haemophilia, renal care, HIV, infectious diseases, plastic surgery, immunology, Parkinson's disease, vascular surgery, cardiology, amyloidosis and scleroderma and we are a member of the academic health science partnership UCLPartners.