Episode Transcript
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Comprehensive, relevant,and insightful conversations about health
and medicine up in hereon MedStar Health DocTalk.
Real conversations withphysician experts from
around the largesthealthcare system in the
Maryland DC region.
Welcome to MedStar Health DocTalk.
I'm Ryan Miller and I'll beyour host for today's episode.
I'm joined by Dr. Talal Al Kaud,an abdominal transplant surgeon
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and urologist specializingin kidney, liver,
and pancreas transplantation, as wellas advanced urologic
oncology and reconstruction.
He focuses on the management of patientswith complex abdominal
and transplant related conditions,specifically those requiring
integration of transplant,urologic, vascular, and
oncologic surgical techniques.
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Dr. Al-Kaud has played akey role in the development
of the robotic kidneytransplantation program,
which is expanding accessto minimally invasive transplant surgery
for select patients.
Thank you so much for joiningus at MedStar Health DocTalk.
Thank you, Ryan. It's an absolutepleasure to be here today.
To start, can you walk usthrough the conditions you treat?
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Sure. In my practice, I treat patientswith end-stage renal disease, patients
with end-stage liverdisease or liver cirrhosis.
And then a unique aspect of my practiceor the conditions I manage are patients
that have advanced urologiconcology conditions
and reconstruction that requiresvascular reconstruction,
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autotransplantation,and using bowel segments
for reconstruction.
Dr. Al Qaoid, you helped startthe robotics program here
at MedStar Georgetown.
Can you tell us about that undertakingand it must be something you're proud of?
Yes, I was very fortunateto have the opportunity
to start the robotickidney transplant program.
You can't just go to themarathon without training, right?
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So it took me a couple of yearsto be able to wrap my head
around, first of all,the indication for it.
You know, I, I like to dothings when it's very solid
and very clear, especiallywhen there's risks
associated with surgery.
I do like innovation, don't get me wrong,but I think it's important to build
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on the evidence that's out there.
So it became very evident to me quicklythat the robot in transplant
surgery is the future.
It's, it's whereeverything's going to head.
And you know, I started using the robotto do the donor operations
and then using the robot to dourologic cases as well.
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And then I started thinking,okay, this is the point.
We need to start doing this.
And it was in the fall of 2025last year when performed the
first robotic kidney transplantoperation here at MedStar
Georgetown University Hospital.
It's been great. I've beenusing the robot to offer it
for the donor operation as wellas the kidney transplant
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recipient operation as well.
Wow, very exciting stuff.
So it sounds like it'sa 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 pastcouple of years.
And we have seen the robot being usedfor the kidney donor operations,
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the kidney transplantoperations, the kidney
and pancreas transplantoperations as well,
and the liver donor andrecipient operation as well.
So it's very exciting aspectof our field in transplant surgery.
Can you tell us the role robots play inyour transplant surgeries?
You're doing them on bothsides, donor and recipient?
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Yes. So for the donor operation, wewere using the laparoscopic
platform for many yearsand there has been a shift to the robot.
And honestly, it translatesinto better patient outcome in
my experience, in my view as well,because we see better with
the robotic camera comparedto the laparoscopic camera.
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And I think you do developa better approach when
you're using the robot.
So yes, we use it and I useit for the donor operation.
And then what I've done recentlyis 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,
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subjective opinion orexperience because from my angle
and the patient's angleas well subjectively is the
patients recover quicker.
They require very littlepain 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 muchmore refined job, at least
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I view it that way when I'm doing thetransplant robotically.
And it's just great to seethat the incision is really
so small compared to whatwe do conventionally.
So I think it's definitely here to stayand it's going to definitely become more
and more applicable for many patientsbecause it's not really
for everybody currently.
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I'm sure everyone's mind'srunning a million miles an hour
when they hear robots likeTerminator two or what have you.
Yeah. Can you explainhow the robot operates?
Is it you push a button and it goes?
How do you actually use it?
AI has not yet replacedour jobs, as they say.
It's not a push of a button.
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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 theports just like we would
for a laparoscopic case, butthen we bring in the robot
and we attach the roboticarms to those ports
and then we put instrumentsinto those ports
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and then we control the robot. So it's -From like a corner of the OR room.
I have had a chance tosee it. It's pretty wild.
Yes. So you are still in the same room.
You are in the corner of the roomand you're controlling everything.
So it's not like the Terminator,it's more like the transformer.
You'reSitting in the robot and controlling it.
And it gives you finer precision?
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Yes.
And smaller minimally invasive?
Yes. So basically you make a small fiveto 10 millimeter incisions
after you kind of fill thebelly with air, as they say,
just to simplify it.
And then we put those ports inand then through those
ports we put the instrumentsand then we have a camera in one
of those ports and then that's it.
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When you mention thisapproach to patients,
do they seem up for it onceyou explain the benefit?
I think the patients need to knowthat 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 delivermore precise surgery
because you have the advantageof the robotic camera,
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which is way much betterthan the laparoscopic camera
that we use for conventionallaparoscopic surgery.
Not everyone can be a candidatefor robotic transplant surgery.
Yes, unfortunately it'snot a one size fits all.
Right now, the biggestadvantage is in the patients
that have a high body mass indexor semi-complex anatomy,
patients that we knowwill have a high risk for
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wound complications basically.
So those patients that have ahigh body mass index, patients
that have had priorsurgeries are chronically
immunosuppressed, patientsthat have, for instance,
polycystic kidney disease.
Those patients have all beenproven to have a higher risk
of wound infectionsand also to add patients
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that are on, for instance,on peritoneal dialysis.
Those patients are also at a higher risk.
So any patient with a higherrisk of wound problems,
higher body mass index, complex anatomy,those are the patients
that fit the criteriafor transplant using the robot.
Patients who have denseor heavy vascular disease, patients
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that have multiple priortransplants, patients
that have a lot ofadhesions intra-abdominally,
those patients are not reallygood candidates right now at
least to utilize the robotic platform,at least not in everybody's hands.
Is there a certain age cutoffwhere you all are not
comfortable with proceedingwith a transplant surgery or
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do you do people of all ages?
Age is just a number, but to be pragmaticand evidence-based, we
don't really cap off a age cutoff,but obviously the older you are,
the more complex your medical history isand your medical condition.
So it makes it morechallenging and more risky.
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That makes sense. So I would sayI transplanted the patient
not long ago, the age of 84.
Wow.
Yes. And she did amazingly.
So she did much better thansomebody 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 haveto be a little bit more
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creative and curious.
Because everybody'slike a snowflake, right?
It's patient specific.
Exactly.
How healthy are you?
Exactly. So it really dependson your medical background
and how fit you are for the surgeryand whether you can undergo the surgery
and whether it's technicallydoable to do the surgery.
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So these are the thingsthat I think will factor
more heavily rather thanjust the age.
Dr. Al-Qaoud, sounds likeyou are optimistic about the
future of transplant care when itcomes to the use of robots.
Is that safe to say?
Yes. I think that's wherethe future is heading.
If I were to kind of bullet point to youwhere I think things are
heading, right now, the majorityof transplants are performed
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by a robotic platformwhere 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 moreand more telesurgeries being
performed in transplant usingthe robot because there's going
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to be a discrepancy in theexperience each program has.
That's one. Two is singleport robotics has become
more and more popularand it has invaded the
transplant surgery world.
So I think that's going tochange as well, especially
for the donor operations.
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And then I think the nicething about the robot too is
that there's going to be competitionbetween companies trying
to create a betteror a more attractive robotic
platform or actual robot.
So there's going to be alot 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.
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It's definitely a toolthat we need to, especially
my generation and the generationafter us, we have to
be very well accustomedto the robotic platform
and what we can offer these patients.
You and your colleagues atMedStar Georgetown Transplant
Institute, you help peopleget off wait lists for organs.
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Can you just explain forthose who are unaware how long
that list can be and justwhy 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 numberof patients suffering from
end-stage renal disease.
And when I say end stage, meaning patientsthat are on dialysis.
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And so those patients, the only cure isgetting a kidney transplant.
And unfortunately, there's around 100to 120,000 people on the wait
list for a kidney transplant.
Wow.
There's just not enough kidneysto transplant patients.
And there's roughly around 17people dying on the wait
list every day waitingfor a kidney transplant.
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So it's a serious problem.
What would you say tothose 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 ofimplications associated with it.
But from a medical standpoint, the actof donation has proven
over many, many years,I would say decades with
long-term data as well,that it is safe in those that
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have a good medical profile,who have lifestyle that's very healthy,
take care of themselves.
They have a low risk ofdeveloping, let's say,
renal failure if theydonate one of their kidneys.
The other aspect to it is that sometimesfor your loved ones, donating a organ is,
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if it's medically soundand 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 specialbond between those two.
100%. And it's obviouslynot everybody is willing
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to undergo all of that,but those that are, those
are courageous peopleand those people are making a huge impact,
a huge difference.
They're gifting life.
And it's the only field in medicinethat it takes one human
being to make it happenfor another human being.
I love that. What do you want patientsto know about the transplant process?
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Are there questions you're not gettingthat you wish they would ask you?
What should they know about it?
I think it's important toknow that for many patients,
I think they are presentedthe option of transplant,
at least the initial presentationbefore they come to get
to us in the clinic hereor a transplant provider,
is that it's an option.
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Yes, it is, but it'sreally the ultimate option.
It is the only option tobe able to go back to life
and have a longer lifeand enjoy a healthy life.
So I think it's importantthat that is emphasized
because that is only whenthe patients realize that
they need to try their best to getthrough the transplant evaluation process
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and advocate for themselvesfor a living donor.
Because not everybody'sfortunate to have a big family
and a loving family anda strong support system.
But there is something to besaid that when you are fighting
for your life, the instinct is different.
The will is different.
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So I think it's importantthat patients understand
that kidney transplantfor end-stage renal disease
is really the only option.
Paralysis is a temporaryfix or it's a bridge To that.
Exactly. And they'renot living the quality
of life they want to livewhen they're on dialysis.
Yes. And it's not harmless.
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Every year your risk of dyingon 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 chooseMedStar Georgetown Transplant
Institute for their care?
I'm going to try and soundas least biased as possible,
but I think the way we provide careto these patients is a team approach.
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Every person in this groupis a piece of the puzzle.
Only when you put all the piecesof the puzzle together
will it be complete.
And I think we've proven that despiteany hurdles any healthcare
system can have.
I think we have proventhat we can function
as a Italian kitchenand have everybody has a specific role
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and everybody takes a lot of pride inwhat they do in that kitchen.
And I think it's the same with us.
We all try and do our bestand we all work together for
the ultimate same outcome.
Well, that's great to hear.
Definitely sounds like you allhave every aspect of care covered.
I've been talking with Dr.
Talal Alcode at MedStarGeorgetown University
Hospital in Washington DC.
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Thank you so much forsharing 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.