Highlights

HighlightsGuy's meeting at London

A Leader & Teacher

  • Unique feat of starting and leading 4 successful and prestigious Urology and Renal Transplantation Programs in India at Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS), Lucknow in 1989, at Apollo Hospital, New Delhi in 1997, Fortis Hospital New Delhi in 2007and at Medanta, the Medicity in year 2010.
  • Initiated Urology training programs at all Institutions of affiliation, M.Ch. Urology at SGPGIMS, Lucknow, and Diplomat National Board (DNB) Urology training program at Apollo Hospital, New Delhi, Fortis Hospital New Delhi and at Medanta, the Medicity.
  • Started 1-year Post Urology training Fellowship courses in Minimally invasive Urology and Renal Transplantation at Medanta and Fortis.

Expertise in Endo-Urology (PCNL) for upper tract

  • First in the country to start Endo-urology program (PCNL and Ureteroscopy) in 1989, while a Faculty member at SGPGIMS, performing both percutaneous access and procedure.
  • Worked with Mike Kellett and Hugh Whitfield, leaders in Endourology during the Institute of Urology Nephrology stint at London, UK during 1995-96.
  • Performed more than 3000 percutaneous nephrolithotomy (PCNL) since 1990.
  • Invited as faculty to almost all National and International Percutaneous Surgery Workshops being held in the country.
  • Performing PCNL in Camp settings, more than ten such procedures in a single day, since 1998, such camps being held every 4 to 6 weeks.

Expertise in Renal Transplantation

  • Executed more than 2500 live related renal Transplants since 1992.
  • Initiated India’s first Laparoscopic Donor Nephrectomy (LDN) program, at Apollo Hospital, New Delhi in 2000, and have one of the largest experience of LDNs.
  • Started the world’s first program of Robotic Recipient surgery under regional hypothermia in 2013 using intra-corporeal hypothermia as International collaboration with Vattikuti Urology Institute, Henry Ford hospital, Detroit, MI.
  • Currently doing more than 250 live related renal Transplantations during one calendar year, one of few such centers in the world.
  • Initiated and established Renal Transplantation program at four different Institutions, at Sanjay Gandhi PGI, Lucknow during early 1990s, at Apollo Hospital, New Delhi in 1997, Fortis Hospital New Delhi in 2007, and at Medanta, the Medicity in year 2010.
  • Renal Transplantation program, vascular access and Cadaver harvesting as Honorary Lecturer at Institute of Urology and Nephrology London, UK for one year in 1985-1986, North Thames region, UK.

 

Expertise in Laparoscopic Urology

  • Live demonstrations of full spectrum of all complex laparoscopic reconstructive and Oncologic procedures (during live workshops), like Pyeloplasty, Partial Nephrectomy, Radical Cystectomy and Radical Prostatectomy at most laparoscopic Urology workshops in India.
  • Vast experience of Laparoscopic Donor Nephrectomy, Laparoscopic Pyeloplasty, and Partial Nephrectomy.
  • First in India to initiate Laparoscopic Radical Prostatectomy program in 2004 and Laparoscopic Partial Nephrectomy program in 2007.
  • A regular invitee as operating Faculty member to demonstrate Laparoscopic procedures during National and International meetings in India.
  • Have won 10 National Best Video awards on Laparoscopic Video presentations.

 

Expertise in Robotic Urology

  • Faculty at 1st and 2nd Worldwide Robotic Surgery 24 hour event2015 (http://wrse24.org/broadcasts/new-delhi/) organised by Karolinska Institute for EAU as one of eight robotic surgery center from four continents to demonstrate live robotic renal transplantation from Medanta, India. The selected eight centers were Karolinska (Peter Wiklund, Abolfazl Hosseini), Aalst Belgium (Alex Mottrei), Guys London (Prokar Dasgupta), Verona in Italy (Walter Artibani), New York (Ash Tewari), Florida (Vip Patel), Los Angeles (Indy Gill, Mihir Desai), Seoul (Koon Rha), New Delhi (Rajesh Ahlawat), and Melbourne (Declan Murphy).
  • Invited to perform live Robotic Renal Transplantation at International events, having demonstrated the technique at Detroit (USA), Bilbao (Spain), Rome (Italy), Barcelona (Spain), Istanbul (Turkey) and Ghent (Belgium).
  • Headed the busiest Robotic Surgery program in India, performing more than 400 Robotic Urology procedures from 2010 to 2016.
  • Initiated country’s most successful Robotic Nephron Sparing Surgery Program and Early Prostate Cancer Surgery Program at Medanta.
  • Spearheaded world’s first Robotic Renal Transplant program under regional hypothermia at Medanta in 2013.
  • Has been visited by various surgical teams from US, Europe and China to observe and learn his Robotic Renal Transplantation technique.
  • He has been invited to demonstrate and perform live Robotic Kidney Transplantation around the globe, to US (Detroit), Europe (Bilbao, Barcelona, Rome, Gent and Istanbul) and various centres in India.

 

Pioneering and disseminating Robotic Renal Transplantation under regional Hypothermia

 

  1. The Background

Renal Transplantation is traditionally performed by open surgical method, unchanged since last 60 years. Patients requiring kidney transplant are prone to infections and are in frail health. There are dreaded surgical complications following open surgery, like wound infection and collections. Theoretically, a Minimally Invasive Kidney Transplant (MIKT), laparoscopic or robotic, would avoid open cutting incision, reduce complications and speed recovery, as has been proved in every other surgical field so far. In past, attempts at MIKT met with limited success due to limited range of movements with laparoscopic instruments and non-uniform and non-standardized approaches. It was also observed that there is slower recovery of kidney function during such attempts, which was attributed to the failure to keep the transplanted organ at desired lower temperature during surgery.

Idea of Robotic Renal Transplantation with hypothermia (maintaining low temperature of the organ during procedure) was conceived in 2012 in a collaborative meeting of Vattikuti Urology Institute, Henry Ford Hospital, Detroit, and Medanta Vattikuti Institute, Medanta, India. There were only two case reports of Robotic Renal Transplantation in literature at that time. The technique for hypothermia was mastered and standardized at Henry Ford Hospital, Detroit. After planning the steps, initial laboratory studies were done at Ohio State University, Columbus, Ohio. Dr. Ahlawat and team conducted successful phase 1 clinical trial of Robotic Renal Transplantation with hypothermia, the first world over, at Medanta Hospital, India, in Jan 2013 after the necessary Institute Review Board and Ethical Committee clearances. Results were gratifying and comparable to the open surgery gold standard, and published in literature.

  1. Present status

One hundred and fifty successful robotic renal transplants were performed at Medanta till April 2016 with excellent results. The monitoring of the technique, data acquisition and its analysis was done in collaboration with Prof. Menon and his team at Vattikuti Urology Institute at Detroit, USA. The results have been peer reviewed and accepted by the scientific community world over, as follows.

  • Initial results were analyzed and reported in 2014-2015 in form of four international publications in high impact journals.
  • Results and the technique were presented at 2014 European Urology Meeting at Stockholm. A 3-D video was also requested and shown at “Surgery in Motion” section of the same meeting.
  • The presentation won the best poster award at 2014 European Urology Meeting at Stockholm.
  • There were six presentations by the group on the technique, its monitoring and the outcomes at 2014 American Urological Association Meeting at Orlando. Robotic Renal Transplantation with regional hypothermia was part of take home message, both in Robotic surgery and Transplantation sections, at conclusion of the meeting (AUA Take Home Messages).
  • A podium presentation at World Congress of Transplantation at San Francisco in July 2014 was one of the best chosen presentation, and led to an invited publication in “Transplantation”.
  • Invitation by ERUS to present updated robotic renal transplantation results at European Association of Urology (EAU) meeting at Madrid in 2015.
  • Invitation for a plenary session presentation at AUA 2015 and a debate on Robotic Renal Transplantation at EAU 2016.
  • A faculty for Worldwide Robotic Surgery 24 hour eventon Feb 16 and 17, 2015 http://wrse24.org/broadcasts/new-delhi/ as one of eight robotic surgery centre from four continents to demonstrate live robotic renal transplantation from Medanta, India. The selected eight centers were Karolinska (Peter Wiklund, Abolfazl Hosseini), Aalst Belgium (Alex Mottrei), Guys London (Prokar Dasgupta), Verona in Italy (Walter Artibani), New York (Ash Tewari), Florida (Vip Patel), Los Angeles (Indy Gill, Mihir Desai), Seoul (Koon Rha), New Delhi (Rajesh Ahlawat), and Melbourne (Declan Murphy).
  • Invited as Faculty for live demonstration of technique of Robotic Renal Transplantation at
    • Live Surgery Symposium on Robotic Renal Transplantation and Renal Surgery “Canli Cerrahi Sempozyumu: Robotik Bobrek Nakil ve Bobera Cerrahisi” at Istanbul to dedonstrate Robotic Renal Transplantation, Sept 2016
    • ” International Live Operative Workshop on Robotic Assisted Urological Surgery” at Max Super Specialty Hospital, Delhi, April 2016. Other operating faculty being Peter Wiklund from Karolinska and Nikhil Vasudeo from UK.
    • Universitair Ziekenhuis at Gent, Belgium to perform live Robotic Renal transplantation at their centre to start their RKT program in Mar 2016. A live case is planned at Gent as part of the training course on Robotic Renal Transplantation as planned with ORSI at Aalst, Belgium.
    • “International Live Operative Workshop on Advanced Robotic and Reconstructive Surgery” at PGIMER, Chandigarh, Feb 2016.
    • Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey to start their Robotic Transplant program. Three successful cases of Robotic Renal Transplant cases were performed from live donor over 2 days in Dec 2015.
    • 54th Fundació Puigvert Urology Course at Barcelona, Spain, Oct 2015.
    • ERUS 2015 at Bilbao, Spain, Sep 2015.
    • 2nd International Translational Research Uro-Sciences Team (iTRUST) in Rome, Italy, Sep 2015.
    • http://wrse24.org/surgeons/rajesh-ahlawat/1st Worldwide Robotic Surgery 24 hour event2015 (WRSE) http://wrse24.org to demonstrate Robotic Kidney Transplantation, Feb 2015.
  • A Chapter on Minimally Invasive Renal Transplantation has been included in text books
    • “Atlas of Transplantation”, edited by Prof Ernesto Molmenti.
    • The technique and video is being included in forthcoming edition of Text Book, Campbell’s Urology, considered the Bible of Urology.
    • Invitation to write chapter on Robotic Renal Transplantation in “Smith’s Text Book of Endourology

Robotic Renal Transplantation has shown the potential to become the standard of care world over.

  1. Dissemination of technique and the future Directions

Dr. Ahlawat is committed to disseminate the technique to other parts of the world.

  • Taking Robotic Renal Transplantation form India to its conception home at Henry Ford Hospital in Detroit was the next logical step. A transplant team consisting of Yoshida and Kim from Henry Ford Hospital visited Medanta to observe Robotic Renal Transplants in March 2014. Three successful such cases have, subsequently, been performed during May 2014 by the transplant team at Henry Ford Hospital, USA, led by Dr. Ahlawat. More cases have been done at Henry Ford Hospital subsequently.
  • Ernesto P. Molmenti, Vice Chairman and Transplant Surgeon at North Shore University Hospital, NY) visited Medanta in June 2014 with his team to observe the technique.
  • Jonathan Olsburgh and Dr Nizam from Guys Hospital, London visited Medanta with other team members in November 2014.Guy's2
  • Alberto Breda, MD, Cheif of the Kidney Transplant Surgical Team, Consultant in Oncologic Urology and Minimally Invasive Surgery, and Dr L Gausa from Department of Urology, Fundació Puigvert, Barcelona, Spain visited Medanta in June 2015 to observe the technique.breda
  • Antonio Alcaraz, chairman and professor at University of Barcelona visited Medanta in June 2015 to observe the technique.antonio alcaraz 2015
  • Chinese delegations of transplant surgeons visited Medanta in Sep. 2015 and Mar 2016 to observe the technique.China
  • Ahlawat was invited to perform live Robotic Renal Transplantation under hypothermia at 2nd International Translational Research Uro-Sciences Team (iTRUST) in Rome, Italy, EAU Robotic Urology Section ERUS 2015 at Bilbao, Spain, 54th Fundacio Puigvert Urology Course at Barcelon, Spain, ” International Live Operative Workshop on Robotic Assisted Urological Surgery” at Max, Delhi, “International Live Operative Workshop on Advanced Robotic and Reconstructive Surgery” at PGIMER, Chandigarh apart from invitations from Universitair Ziekenhuis, Gent, Belgium and Bakirkoy Dr. Sadi Konuk Hospital, Istanbul, Turkey (performed three live cases).

There is a need to carefully disseminate the standardized technique of Robotic Renal Transplantation, to prevent failures and to have uniform results. It will also allow collection of experience from multiple centers, necessary to establish the technique. After initial enthusiasm, there is also a need to find the correct place of the procedure by planning and performing level I scientific monitored trials over next couple of years.