Robot Assisted Transplant Surgery with Dr. Talal Al-Qaoud

On this episode of DocTalk, we talk with Dr. Talal Al-Qaoud, transplant surgeon and urologist at MedStar Georgetown University Hospital, who explains how robotic-assisted transplant surgeries are improving patient outcomes, and what makes someone an ideal candidate.

For an interview with Dr. Al-Qaoud, or for more information about this podcast, contact Medstar Georgetown University Hospital manager of Media Relations, Ryan.M.Miller2@Medstar.net.

Learn more about Dr. Al-Qaoud 

For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Transcript

0:05

Comprehensive, relevant, and insightful conversations about health and medicine up in here on MedStar Health DocTalk. Real conversations with physician experts from around the largest healthcare system in the Maryland DC region. Welcome to MedStar Health DocTalk. I'm Ryan Miller and I'll be your host for today's episode. I'm joined by Dr. Talal Al Kaud, an abdominal transplant surgeon and urologist specializing in kidney, liver, and pancreas transplantation, as well as advanced urologic oncology and reconstruction. He focuses on the management of patients with complex abdominal and transplant related conditions, specifically those requiring integration of transplant, urologic, vascular, and oncologic surgical techniques. Dr. Al-Kaud has played a key role in the development of the robotic kidney transplantation program, which is expanding access to minimally invasive transplant surgery for select patients. Thank you so much for joining us at MedStar Health DocTalk. Thank you, Ryan. It's an absolute pleasure to be here today. To start, can you walk us through the conditions you treat? Sure. In my practice, I treat patients with end-stage renal disease, patients with end-stage liver disease or liver cirrhosis. And then a unique aspect of my practice or the conditions I manage are patients that have advanced urologic oncology conditions and reconstruction that requires vascular reconstruction, autotransplantation, and using bowel segments for reconstruction. Dr. Al Qaoid, you helped start the robotics program here at MedStar Georgetown. Can you tell us about that undertaking and it must be something you're proud of? Yes, I was very fortunate to have the opportunity to start the robotic kidney transplant program. You can't just go to the marathon without training, right? So it took me a couple of years to be able to wrap my head around, first of all, the indication for it. You know, I, I like to do things when it's very solid and very clear, especially when there's risks associated with surgery. I do like innovation, don't get me wrong, but I think it's important to build on the evidence that's out there. So it became very evident to me quickly that the robot in transplant surgery is the future. It's, it's where everything's going to head. And you know, I started using the robot to do the donor operations and then using the robot to do urologic cases as well. And then I started thinking, okay, this is the point. We need to start doing this. And it was in the fall of 2025 last year when performed the first robotic kidney transplant operation here at MedStar Georgetown University Hospital. It's been great. I've been using the robot to offer it for the donor operation as well as the kidney transplant recipient operation as well. Wow, very exciting stuff. So it sounds like it's a fairly new field then. Yes, it's very exciting. It's evolving. It's not really infantile anymore. It was started roughly a decade ago, but it's picked up significantly in the past couple of years. And we have seen the robot being used for the kidney donor operations, the kidney transplant operations, the kidney and pancreas transplant operations as well, and the liver donor and recipient operation as well. So it's very exciting aspect of our field in transplant surgery. Can you tell us the role robots play in your transplant surgeries? You're doing them on both sides, donor and recipient? Yes. So for the donor operation, we were using the laparoscopic platform for many years and there has been a shift to the robot. And honestly, it translates into better patient outcome in my experience, in my view as well, because we see better with the robotic camera compared to the laparoscopic camera. And I think you do develop a better approach when you're using the robot. So yes, we use it and I use it for the donor operation. And then what I've done recently is you started using it as of the fall of last year, 2025, where we did the first robotic kidney transplant here. And I've seen an amazing, at least I would say, subjective opinion or experience because from my angle and the patient's angle as well subjectively is the patients recover quicker. They require very little pain management post-op. They're up and about quicker. They're back to life quicker. The surgery is much smoother, to be honest with you. I feel like we do a much more refined job, at least I view it that way when I'm doing the transplant robotically. And it's just great to see that the incision is really so small compared to what we do conventionally. So I think it's definitely here to stay and it's going to definitely become more and more applicable for many patients because it's not really for everybody currently. I'm sure everyone's mind's running a million miles an hour when they hear robots like Terminator two or what have you. Yeah. Can you explain how the robot operates? Is it you push a button and it goes? How do you actually use it? AI has not yet replaced our jobs, as they say. It's not a push of a button. It's a platform that we use, or it's a tool really that we use to deliver better surgeries for patients. So basically we put in the ports just like we would for a laparoscopic case, but then we bring in the robot and we attach the robotic arms to those ports and then we put instruments into those ports and then we control the robot. So it's - From like a corner of the OR room. I have had a chance to see it. It's pretty wild. Yes. So you are still in the same room. You are in the corner of the room and you're controlling everything. So it's not like the Terminator, it's more like the transformer. You're Sitting in the robot and controlling it. And it gives you finer precision? Yes. And smaller minimally invasive? Yes. So basically you make a small five to 10 millimeter incisions after you kind of fill the belly with air, as they say, just to simplify it. And then we put those ports in and then through those ports we put the instruments and then we have a camera in one of those ports and then that's it. When you mention this approach to patients, do they seem up for it once you explain the benefit? I think the patients need to know that we are controlling the robot, number one. You're still the surgeon. Yes. You are in the operating room. You are controlling everything. You can definitely deliver more precise surgery because you have the advantage of the robotic camera, which is way much better than the laparoscopic camera that we use for conventional laparoscopic surgery. Not everyone can be a candidate for robotic transplant surgery. Yes, unfortunately it's not a one size fits all. Right now, the biggest advantage is in the patients that have a high body mass index or semi-complex anatomy, patients that we know will have a high risk for wound complications basically. So those patients that have a high body mass index, patients that have had prior surgeries are chronically immunosuppressed, patients that have, for instance, polycystic kidney disease. Those patients have all been proven to have a higher risk of wound infections and also to add patients that are on, for instance, on peritoneal dialysis. Those patients are also at a higher risk. So any patient with a higher risk of wound problems, higher body mass index, complex anatomy, those are the patients that fit the criteria for transplant using the robot. Patients who have dense or heavy vascular disease, patients that have multiple prior transplants, patients that have a lot of adhesions intra-abdominally, those patients are not really good candidates right now at least to utilize the robotic platform, at least not in everybody's hands. Is there a certain age cutoff where you all are not comfortable with proceeding with a transplant surgery or do you do people of all ages? Age is just a number, but to be pragmatic and evidence-based, we don't really cap off a age cutoff, but obviously the older you are, the more complex your medical history is and your medical condition. So it makes it more challenging and more risky. That makes sense. So I would say I transplanted the patient not long ago, the age of 84. Wow. Yes. And she did amazingly. So she did much better than somebody who's in their 60s. That's incredible. So I think in age, when I said age is just a number at the beginning, it is in this field because you kind of have to be a little bit more creative and curious. Because everybody's like a snowflake, right? It's patient specific. Exactly. How healthy are you? Exactly. So it really depends on your medical background and how fit you are for the surgery and whether you can undergo the surgery and whether it's technically doable to do the surgery. So these are the things that I think will factor more heavily rather than just the age. Dr. Al-Qaoud, sounds like you are optimistic about the future of transplant care when it comes to the use of robots. Is that safe to say? Yes. I think that's where the future is heading. If I were to kind of bullet point to you where I think things are heading, right now, the majority of transplants are performed by a robotic platform where you're in the operating room. I think moving forward, there's going to be a lot of inter-program teaching and mentoring, and that's going to definitely involve telesurgery. So I think there's going to be more and more telesurgeries being performed in transplant using the robot because there's going to be a discrepancy in the experience each program has. That's one. Two is single port robotics has become more and more popular and it has invaded the transplant surgery world. So I think that's going to change as well, especially for the donor operations. And then I think the nice thing about the robot too is that there's going to be competition between companies trying to create a better or a more attractive robotic platform or actual robot. So there's going to be a lot of options on the shelf to choose from in the future as well. So yes, the robot is here. It's not going to leave. It's definitely a tool that we need to, especially my generation and the generation after us, we have to be very well accustomed to the robotic platform and what we can offer these patients. You and your colleagues at MedStar Georgetown Transplant Institute, you help people get off wait lists for organs. Can you just explain for those who are unaware how long that list can be and just why there is such a dire need for more organ donors? To put it in a simplistic manner, the supply does not meet the demand. Unfortunately, there's a huge number of patients suffering from end-stage renal disease. And when I say end stage, meaning patients that are on dialysis. And so those patients, the only cure is getting a kidney transplant. And unfortunately, there's around 100 to 120,000 people on the wait list for a kidney transplant. Wow. There's just not enough kidneys to transplant patients. And there's roughly around 17 people dying on the wait list every day waiting for a kidney transplant. So it's a serious problem. What would you say to those who are thinking about becoming an organ donor? I think it's a beautiful thing. Again, this is easier said than done. There's obviously a lot of implications associated with it. But from a medical standpoint, the act of donation has proven over many, many years, I would say decades with long-term data as well, that it is safe in those that have a good medical profile, who have lifestyle that's very healthy, take care of themselves. They have a low risk of developing, let's say, renal failure if they donate one of their kidneys. The other aspect to it is that sometimes for your loved ones, donating a organ is, if it's medically sound and indicated and feasible and there's no contraindications, is the most beautiful gift you can give to your loved one, whether it's a family member or a friend, or if sometimes it's altruistic and - To a total stranger, you mean? A total stranger, yes. It's a beautiful thing. That creates a special bond between those two. 100%. And it's obviously not everybody is willing to undergo all of that, but those that are, those are courageous people and those people are making a huge impact, a huge difference. They're gifting life. And it's the only field in medicine that it takes one human being to make it happen for another human being. I love that. What do you want patients to know about the transplant process? Are there questions you're not getting that you wish they would ask you? What should they know about it? I think it's important to know that for many patients, I think they are presented the option of transplant, at least the initial presentation before they come to get to us in the clinic here or a transplant provider, is that it's an option. Yes, it is, but it's really the ultimate option. It is the only option to be able to go back to life and have a longer life and enjoy a healthy life. So I think it's important that that is emphasized because that is only when the patients realize that they need to try their best to get through the transplant evaluation process and advocate for themselves for a living donor. Because not everybody's fortunate to have a big family and a loving family and a strong support system. But there is something to be said that when you are fighting for your life, the instinct is different. The will is different. So I think it's important that patients understand that kidney transplant for end-stage renal disease is really the only option. Paralysis is a temporary fix or it's a bridge To that. Exactly. And they're not living the quality of life they want to live when they're on dialysis. Yes. And it's not harmless. Every year your risk of dying on dialysis is around 10 to 12% and it adds up. Geez. It adds up. So it's not benign. It's not harmless. Why should patients choose MedStar Georgetown Transplant Institute for their care? I'm going to try and sound as least biased as possible, but I think the way we provide care to these patients is a team approach. Every person in this group is a piece of the puzzle. Only when you put all the pieces of the puzzle together will it be complete. And I think we've proven that despite any hurdles any healthcare system can have. I think we have proven that we can function as a Italian kitchen and have everybody has a specific role and everybody takes a lot of pride in what they do in that kitchen. And I think it's the same with us. We all try and do our best and we all work together for the ultimate same outcome. Well, that's great to hear. Definitely sounds like you all have every aspect of care covered. I've been talking with Dr. Talal Alcode at MedStar Georgetown University Hospital in Washington DC. Thank you so much for sharing your expertise with us today on MedStar Health Doc Talk. Thank you very much, Ryan, for this opportunity. It's been an absolute pleasure. Thanks for your time. For more information, sit medstarhealth.org/transplant.