How Robotic Assisted Surgery Is Redefining Precision in Kidney Transplants

In an interaction with India Pharma Outlook, Dr. Mohan Keshavamurthy, Principal Director – Renal Sciences at Fortis Healthcare, discusses how robotic surgery is revolutionizing kidney transplants in India by improving surgical precision, reducing warm ischemia time, minimizing complications, and enabling faster recovery in anatomically complex cases. Dr. Mohan Keshavamurthy brings over 30 years of experience and specializes in complex urological procedures, kidney transplants, robotic surgery, and reconstructive urology, with strong expertise in minimally invasive techniques and high-risk surgical care.

As robotic kidney transplants are adopted in high-volume Indian centers, how is this shift improving vascular anastomosis precision in obese or high-risk patients?

Vascular anastomosis has undergone substantial improvements as robotic kidney transplants have become more popular in large-scale Indian hospitals, particularly for obese or high-risk patients. The utilization of Gore sutures is one main cause. Gore sutures prevent leaking almost fully, considering the needle and thread share an identical diameter, unlike traditional sutures where the diameter of the needle is bigger compared to the thread, resulting in some leakage. 

Another significant advancement is the robot's capability to deliver what feels like two dominant hands. Normally, a surgeon uses their dominant hand more effectively than the other, but robotic instruments give articulation and precision across both. This is compared to using a Singer sewing machine—you can clearly see both the needle’s entry and exit points in binocular vision, which isn’t possible when hand-sewing a button.

A further significant aspect is the robot's magnification. Traditional surgeries used loops of 3.5x to 4x magnification. Currently, every individual in the operating theater is able to clearly witness the entire process because of the robotic equipment that demonstrates 30x magnification and displays across several screens. Equivalent to live social media, this promotes immediate analysis and correction, enabling errors to be identified and addressed swiftly.

The robotic device enables nearly error-free anastomosis even in young patients or tiny vessels with limited room. Overall, vascular anastomosis is now far safer and far more precise compared to predecessors because of the robot's Gore sutures, improved sight, precision instruments, and collaborative effort.

Also Read: The Future of Kidney Transplants in India

How is robotic assistance changing the surgeon’s approach to minimizing complications during kidney transplant surgeries, especially in patients with complex anatomical profiles?

The procedure that surgeons perform difficult kidney transplant procedures is now being transformed by robotic assistance, especially in those cases when the donor or patient has difficult anatomical complications. I’ll divide this into two parts. On the donor side, complications might arise with a right kidney containing multiple arteries or a very short vein, with just a single artery being as narrow as two millimeters, as in heart surgery.  It is challenging to reach the kidney when the donor is fat.  Additionally, female donors who have undergone several cesarean sections can have scars and adhesions. In all these conditions, the robot handles the anatomical difficulties and still delivers a healthy kidney.

Now on the recipient side, problems can include multiple arteries to attach, or a patient undergoing their second or third transplant. In some circumstances, including autosomal dominant polycystic kidney disease, wherein the kidneys can expand to a size of 20 to 25 cm and there is no room for a new kidney, the native, failed kidney has to be removed. Others may have a neurogenic bladder that needs reconstruction before connecting the new kidney.

With robotic assistance, safe, precise, and efficient surgical solutions are offered for all of these anatomical complications in both the donor and the recipient. When things are complex, it really makes a difference.

In what ways is the use of robotics during kidney transplants helping to shorten patient recovery times and reduce hospital stay durations in India's top transplant centers?

In the past, patients who underwent kidney transplants remained for about 10 days, whereas donors remained for up to 7. Owing to robots, patients return home in four days, and donors the next day. So, the hospital stay is reduced by half. In addition to the elimination of the risk of infection or lymph collection that used to be prevalent prior open surgery, pain medication is no longer actually necessary. The patient no longer experiences any discomfort, infection, blood transfusion, or lymphocytes, and it now resembles a standard, non-transplant surgery. All of this makes robotic kidney transplant a big improvement over open surgery. The positive aspects that are a shorter hospital stay, fewer problems, and a precisely painless recovery are apparent. The robot ultimately leads to a safer and more effortless experience.

Also Read: Impact of Human Factors Engineering on Medical Device Safety

What role is robotic surgery playing in reducing warm ischemia time during kidney transplants, and how does that impact graft longevity in Indian patients? 

Warm ischemia used to be around 3 to 4 minutes when we do laparoscopic or open kidney harvest. At present, robotic surgery requires nearly a minute, making it a significant leap. Similarly, the immediate and long-term function of the graft is significantly improved when warm ischemia remains below one minute. All of this contributes to avoiding a condition referred to as delayed graft function, or DGF.  Put simply, less warm ischemia implies no DGF, which implies that the graft functions more effectively and lasts longer. Therefore, lowering the duration of warm ischemia utilizing robotic surgery directly contributes to the prolonged survival of grafts in Indian patients. The primary benefit can be obtained here. Accordingly, robotic surgery creates major improvements by lowering warm ischemia and improving kidney transplantation results throughout the short and long term.

As robotic platforms evolve, how are surgeons balancing the trade-off between enhanced dexterity and the steep learning curve in renal transplant scenarios? 

The practice of open surgery is slowly becoming extinct, while new surgeons are currently trained in robotic, laparoscopic, and endoscopic procedures. This has been a slow yet fascinating journey through every stage of surgical development for me personally, starting with open surgery and advancing to endoscopic and laparoscopic techniques finally starting robotic surgery at the age of 50.

In India, long-term patient benefit, cost, and effectiveness are all taken into consideration. The robot increases the results of individual pelvic treatments, including kidney transplants or prostate cancer surgeries. Determining which patients require robotic surgery, reducing costs, and making efficient use of the very handful available robotic devices must all be balanced.

The robot is especially helpful in difficult kidney transplants considering dialysis is difficult when a kidney fails. I believe robotic transplants will increase in India with reduced or comparable costs to open surgery, where high volume and value must meet—more cases done at lower cost, but with better outcomes, like the Apple phone model: deliver the best, fastest, and cheapest; that’s where robotic transplants in India are headed.