Team performs world's first robotic liver transplant
By: Bibi Tella
Transplant surgeons performed the world's first minimally-invasive liver resection for living-donor transplantation last week at the University of Illinois Medical Center. Gary Tongue, a Rockford area man, was the first to receive this transplantation performed by robotic surgical techniques. Charles Tongue, his half-brother, was the donor of the liver. When Charles realized how high his half-brother's risks were, Gary decided he could donate a portion of his liver to him and potentially save his life.
UIC's chief of general surgery, Dr. Pier Cristoforo Giulianotti and his colleague Dr. Fabio Sbrana, used the da Vinci Robotic Surgical System to remove 60 percent of Charles Tongue's liver. Surgeons then placed Charles' liver into his half-brother, Gary. The process would have included a long incision covering the entire upper abdomen that is required to remove the right lobe of the liver. UIC's surgical team, aided by the da Vinci Robotic System, used a different approach. They completed the procedure through four small incisions. They then removed the lobe through a three-inch incision in the lower abdomen to minimize any postoperative pain that patients might experience because their blood-type was a match.
According to Giulianotti, "this transplant could be a turning point event heralding a new era in living-donor liver transplantation. The possibility of offering the donor a perfect minimally-invasive operation, increasing the accuracy of the resection while minimizing operative risk and blood loss, is a major step forward."
Gary Tongue was diagnosed with hepatitis C a year ago and also developed a cancerous tumor on his liver.
"The tumor started the clock ticking against Gary," said Dr. Enrico Benedetti, professor and head of surgery at UIC. Benedetti explained the importance of tumors by saying, "when we diagnose a tumor that is less than five centimeters in size, the patient typically does well and the liver transplant surgery is successful," he said. "Patients with tumors larger than five centimeters often don't do as well," he said. "Since Gary's tumor was less than five centimeters in size, his expected survival at one year is above 90 percent, especially now that the risk of surgical complications is virtually over."
Benedetti further explained transplantations by clarifying the risks involved. "We discuss openly the risk of the donor procedure with prospective donors and we routinely involve an ethical committee representative to ensure that the potential donor has fully understood the risks," said Benedetti. "We quote a risk of mortality of 0.2-0.5 percent, according to the current Literature data. We also quote a risk of about 30 percent of complications, including potential for bleeding, leak of bile, infection etc. Usually after resection the liver will regenerate to full size within five to seven weeks."
"Living donor liver transplantation is a life-saving option, especially for a patient with liver cancer," Benedetti said, "but it's very important that the donor understands the risks and be healthy enough to be a good candidate." He pointed out that in order to do this surgery doctors must operate on a healthy man to remove much of his liver. In the Tongues' case, Charles didn't hesitate to offer his liver to his half-brother, Gary.
"I couldn't ask Charles to do this, but he insisted," said Gary. Charles, who had worked in shipping and receiving at a factory outside of Rockford, was in good shape for a man of 53. To ensure his liver would be in excellent condition for the transplant, he lost 22 pounds in four months. Charles Tongue was released from the hospital on Apr. 11. Gary was released around Apr. 15 and soon hopes to resume his Rockford siding business that he started in 1976.
Dr. Benedetti said, "Both Charles and Gary are doing extremely well. They both had excellent liver function tests and no evidence of ongoing complications. At Gary's stage, the risk of future complications is quite low." When asked about any upcoming transplants for UIC using the robotic surgical technique, Dr. Benedetti said, "We are currently evaluating two additional pairs of donor/recipients interested in the procedure."
The liver was placed into Gary Tongue by Dr. Enrico Benedetti and Dr. Jose Oberholzer, director of cell and pancreas transplantation at the UIC Medical Center. In addition to his work with this study, Dr. Oberholzer has been working to find a functional cure for diabetes. Because doctors are dependent on a limited number of pancreases from deceased donors, Oberholzer, along with international doctors and scientists, are trying to multiply the number of crucial islet cells once they are harvested from a pancreas. Should this be a success, Oberholzer would solve one significant problem directly related to islet transplantation. He is currently trying to double and triple the number of diabetics that can be helped, but he hopes to one day make the cells multiply by the hundreds. Dr. Oberholzer and Dr. Benedetti were both highly qualified to perform Gary Tongue's surgery.