Robotics and transplantation

Published on November 09, 2023

José Oberholzer has been operating with the robot for 20 years. He and his team in Chicago were the first in the world to introduce this technique in transplantation.

Minimally invasive procedures, in which instruments fitted with cameras are inserted through small incisions in the skin, have been around for a long time. However, these instruments are stiff, comparable to Chinese chopsticks. In addition, the surgeon only sees a 2D image during these procedures and has to imagine the spatial depth. Complex procedures therefore require a great deal of experience and many years of practice.

Orientation in 3D

In contrast, the robot translates the surgeon’s hand movements one-to-one and can also perform rotations and special angles. It also calculates a 3D visualization, which makes orientation much easier. Another major advantage for José Oberholzer: “The learning curve with the robot is incredibly steep. Surgeons are already independent after just a few operations.”

Targeted use

In José Oberholzer’s view, the use of robotics is ideal for the removal of a kidney (or liver lobe) from a living donor. Four small incisions are made: one on the left and one on the right for the “hands”, a small incision for the camera and a slightly longer one in the bikini area for the actual organ removal. Before the operation, the abdominal cavity is inflated with gas to create space between the organs. During the bikini incision, a special instrument is inserted to separate the organ and pull it out of the abdomen, wrapped in a kind of bag. This minimizes the risk and burden for the donor.

An opportunity for obese patients

The actual transplantation, on the other hand, will continue to be performed as an open operation, which Oberholzer believes should remain the case. With one restriction: very obese patients with a BMI over 35 have often not been able to benefit from a transplant due to the enormously high risk of wound infection. This was also the case in the USA, where two out of five dialysis patients have a BMI of over 35 and therefore had no access to a transplant. Until the day a patient came forward and insisted on a robotic operation with a minimally invasive approach.

After detailed discussion and based on many years of experience with robotic surgery, the team took the plunge – with success. Studies have since clearly confirmed this: If obese patients undergo kidney transplantation using robotics, the long-term outcome is just as good as for normal-weight patients.

Intervention now also possible at the USZ

There are now several centers in the USA that perform the procedure in a standardized way, but only a few in Europe. And at the USZ? “We have already established robotic kidney removal here, and soon we will also be able to perform transplants.” An important goal for José Oberholzer: “We are giving overweight patients a fair chance of a better and longer life without dialysis.”

José Oberholzer, Prof. Dr. med.

Chief Physician, Chairman of the Department, Department of Visceral Surgery and Transplantation

Tel. +41 44 255 33 00
Specialties: Tumor surgery of the abdomen, including liver, bile ducts and pancreas, Transplant surgery for adults and children (liver, pancreas, kidney, small intestine, islet cells, parathyroid tissue)., Robotically assisted minimally invasive surgery of the liver, bile ducts and pancreas, as well as kidney and pancreas transplantation