Cedars-Sinai Medical Center has completed its first fully robotic kidney transplant, marking a significant development in the use of minimally invasive surgical techniques for organ transplantation. The procedure was performed by Dr. Justin Steggerda at the Comprehensive Transplant Center.
For almost two years, Cedars-Sinai’s Kidney Transplant Program has used robotic technology to perform living-donor nephrectomies, which involve removing a kidney from a donor. However, this is the first time the recipient surgery has been conducted using robotic assistance at the institution.
“The stakes are quite a bit higher when it comes to putting a kidney in,” said Steggerda. “The risk of bleeding increases because you’re not just cutting and stapling vessels but actually opening them up and sewing them together to get the transplanted kidney positioned well to where it can be reperfused and maintain good blood flow.”
Cedars-Sinai joins a small group of hospitals in the United States that have performed fully robotic kidney transplants, positioning itself as an innovator in transplant surgery.
Steggerda explained some benefits of robot-assisted surgery: “The primary advantage of a robotic approach is a smaller incision, which means less pain and lower risk of infection. This leads to a faster recovery, faster return to work and reduced reliance on pain medication. These are all big advantages for patient-centered outcomes.”
He clarified that robots do not operate independently during these procedures: “There is a misconception that robots are doing the surgery itself, and that is not true. Robots do not act autonomously. We are controlling them every step of the way, so, in fact, it may be more appropriate to refer to it as robot-assisted surgery. But the advantage of using the robot is that the instruments can be much more dexterous, allowing the procedure to be more minimally invasive.”
Describing differences between traditional and robotic surgeries, Steggerda said: “A kidney is about the size of a human fist, so any incision needs to be at least wide enough to get the organ in. For a robotic procedure, that incision is approximately the length of my palm. In a standard, open procedure, the incision is wider—closer to the length of my entire hand—so you can not only get the kidney in, but you can also see around it and get your instruments in to complete the operation.”
He also noted specific risks with this method: “The biggest challenge of a robotic transplant procedure is getting into the abdomen safely and operating around other organs that may be in the way. This is different from a traditional, open procedure… In a robotic transplant, we must be cognizant of the other organs that may be in our operative field, making the procedure more highly specialized.”
Certain patients stand to benefit most from this approach: “Patients with a body mass index over 35 or 40 are at an increased risk for wound infections, which have been associated with worse kidney transplant outcomes in the long term. By reducing some of those risks, we expect to see better outcomes in that population of patients.”
Looking ahead for Cedars-Sinai’s program growth plans: “Robotic kidney transplant at Cedars-Sinai is a program that we want to continue to grow. It will allow us to expand the number and types of patients that we transplant, with better outcomes. It’s really the future of transplantation in general.”
Steggerda emphasized individualized care: “It’s important to note…that we are working with a fragile population with end-stage kidney disease, and robotic surgery may not be the right technique for every patient. We will always evaluate every case individually to make sure we personalize the best possible care for each patient. In the short three-to-five-year view, we hope to be performing up to 40% of these transplant procedures robotically as we continue to drive innovation further and stay on the leading edge of kidney transplantation surgery.”
Cedars-Sinai Medical Center was established in Los Angeles in 1902 and currently operates under President Thomas M. Priselac. The hospital serves as both an adult treatment center and training facility; according to its 2022 annual report it admitted over 50,000 patients during that year.
More information about how robotic surgery works can be found through Cedars-Sinai Stories & Insights.
