Surgeons perform breakthrough robotic liver-kidney transplant

A US surgical team has carried out the world’s first reported robotic combined liver and kidney transplant.
This milestone at the WashU Medicine and Barnes-Jewish Transplant Centre demonstrates the benefits of minimally invasive transplant surgery for a patient needing both organs.
In 2020, WashU Medicine surgeon Adeel Khan, a pioneer in robotic surgery who helped advance its use to abdominal organ transplantation, performed one of the first robotic kidney transplants in the US at Barnes-Jewish Hospital. In 2023, he performed the country’s first robotic liver transplant at Barnes-Jewish.
This latest clinical advancement, led by Khan and Jessica Lindemann, an assistant professor of surgery at WashU Medicine, shows that a robotic approach may also be feasible for carefully selected patients who need multiple organs transplanted.
Patient Darrell Bosworth underwent the combined robotic liver-kidney transplant in May after developing failure of both organs as a result of advanced liver disease and cirrhosis.
Khan said: ‘Patients who require simultaneous liver and kidney transplantation are often among the sickest and most fragile patients we care for. Their bodies are already under tremendous physiologic stress after months or years of advanced organ failure. Our goal was to perform both transplants safely while minimising the physical and psychological impact of surgery, giving him the best possible opportunity for a faster and smoother recovery.’
Lindemann said: ‘The liver transplant portion is the more complicated surgery, and we carefully worked through every step of both operations. We were very deliberate about the sequence of the operations, how we would use the robotic approach and how the entire team would work together so each step could be performed safely and efficiently.’
The team performed the liver transplant first in an operation lasting just over eight hours. Khan operated from the robotic surgical console, while Lindemann worked bedside, providing manual support and access to the needed areas during critical portions of the operation.
They removed the original liver and transplanted the donor liver through a single three-inch incision, connecting the key blood vessels and bile ducts via smaller secondary incisions. By contrast, traditional open abdominal surgery typically involves a 16- to 20-inch incision and requires cutting through most of the abdominal muscles.
The following morning, Bosworth’s new liver was functioning well, and the team returned to the operating room to perform the kidney transplant. Using the same incisions as the liver transplant, Khan and Lindemann completed the robotic kidney transplant in just over half the time the liver transplant had taken.
Khan said: ‘It reflects years of experience, team development, and a thoughtful and deliberate commitment by WashU Medicine and Barnes-Jewish Hospital to advance surgical innovation safely and rigorously. That infrastructure allows us to consider approaches for our patients that would not otherwise be possible. Our hope is that, over time, these approaches will allow more transplant patients to benefit from less invasive surgery and an easier recovery.’