24 May 2023

Guy’s hospital's consultant surgeon talks about the pioneering robotic kidney donor programme, and how transplantations can transform lives.

What is your role within King's Health Partners?  

In 2013 I was appointed consultant surgeon at the Guy's Hospital Transplant Unit. My role is to assess, operate and follow up on patients with kidney and pancreas failure. As part of my job I perform kidney transplantation for end-stage kidney disease patients, combined kidney and pancreas transplantation for patients with kidney failure and diabetes, and vascular access surgery for patients who need dialysis. 

I operate on live kidney donors performing both laparoscopic and robotic nephrectomy. Finally, I am part of the paediatric kidney transplant team and perform kidney transplants and vascular access surgery on children with kidney failure at Great Ormond Street and Evelina London children's hospitals.  

Tell us more about the robotic surgery programme with live donors?  

Robotic surgery has gained significant popularity amongst all surgical specialties due to its unique advantages. The robot offers the surgeon, magnified and 3-dimensional view, and fine instrument movements. This translates into less surgical complications and faster patient recovery. Transplant surgery, due to its complexity, was one of the last surgical specialties to adopt a robotic approach. 

However, in recent years there is a fast expansion in the use of the robot around the world for transplant procedures. At Guy's Hospital, we started robotic donor nephrectomy in 2018, initially as a pilot program on selective donors and since 2021 as a standard of care for all our kidney donors alongside laparoscopic donor nephrectomy.  

We are currently the only centre in UK to offer the procedure and we have performed more than 50 operations so far. Both in literature and in our results, this has been a safe operation with excellent donor recovery. The procedure has excellent adaptations by kidney donors. We are now expanding our team with more surgeons having training on the procedure.  

 

How will the programme benefit patients?  

Donor nephrectomy is unique, in that a person has an operation to benefit another person but with no advantage for themselves. As such, it is imperative to ensure the least of harm and the best overall experience for the donor. Laparoscopic donor nephrectomy has been the standard of care in previous years. Its results are good, however, there are still areas for improvement, such as infectious complications, recovery time and overall donor satisfaction.  

Since robotic donor nephrectomy was introduced in clinical practice, many publications have analysed its outcomes and compared it with the laparoscopic procedure. The results show that the robotic approach is as safe as the laparoscopic with comparable or even better outcomes. Guy's Hospital has the biggest live donor program in the country, with more than 100 living kidney donors per year. The robotic kidney donor program started in 2018 and, having performed more than 50 cases, we are pleased to see that this is a safe procedure with very good results. We believe that as our experience increases, we will be able to further improve donor recovery and overall experience and allow kidney donors to fulfil their humanitarian work with the least disruption for their lives.  

 

What inspired you to get into this work? 

Transplantation is unique in allowing the surgeon to transform patients' lives by giving them a new organ and a new opportunity. Even on the operating table to see the kidney perfused with recipient's blood and come into life offers very special and satisfying feeling. Furthermore, transplantation offers a unique field for innovation. 

 

What would be your one career top tip? 

Make your hobby your job, so you never have to work! 

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