Setting new standard for urology and kidney transplantation in Sri Lanka

Sri Jayewardenepura General Hospital (SJGH) Consultant Urologist and Transplant Surgeon Dr. Niroshan Seneviratne recently delivered the prestigious SAARC oration at the College of Surgeons. 

He has been at the forefront of advancing kidney transplantation in the country. 

Dr. Seneviratne’s pioneering work includes introducing laparoscopic donor nephrectomy and robotic-assisted surgeries to Sri Lanka. As a co-founder of the Organ Donation and Transplant Foundation, he has been instrumental in raising awareness about organ donation and establishing the National Organ Donor Card program.

His leadership extends beyond national borders, serving as the President of the International Community for Belt and Road Cooperation Alliance on Organ Donation and Transplantation. Dr. Seneviratne’s dedication to advancing transplant surgery and urology in Sri Lanka has not only saved countless lives but also positioned the country as an emerging leader in organ transplantation in the region.

What are the most common urological procedures performed at the SJGH Urology and Transplant Unit?

The SJGH Urology and Transplant Unit provides comprehensive care for a variety of urological conditions. They perform stone removal laser surgeries for kidney, ureter and bladder stones, treat prostate diseases, and address kidney and penile conditions. Additionally, they specialise in managing urological cancers, including those of the kidney, bladder, prostate, and penis. SJGH Urology and Transplant Unit offers sexual health services as part of their outpatient clinics. The dedicated team provides confidential and professional care for a range of sexual health concerns, ensuring that patients receive holistic treatment that addresses all aspects of their urological and reproductive well-being. They also offer kidney transplant services and recently announced their plans to introduce combined kidney-pancreas transplants in the near future, which would be a significant advancement for urological care in Sri Lanka.

What are some of the unit’s most significant achievements in recent years?

In recent years, the Urology and Transplant Unit at SJGH has achieved remarkable success. In 2021, they were recognised as the number one transplant unit in the country, performing 52 kidney transplants. Last year alone, they conducted nearly 1,000 surgeries and over 2,000 endoscopic procedures, while also seeing more than 4,000 patients in the outpatient clinics.

This success is made possible by the dedicated team of five experienced senior medical officers who work tirelessly to ensure that patients receive the best care, even amidst challenging circumstances like limited resources and an economic crisis. Their commitment and teamwork have been essential in providing high-quality urological services to our community.

A successful transplantation requires more than just surgical skill – It demands a dedicated team working with trust, compassion, and commitment. Each member plays a vital role in ensuring the safety and well-being of the donor and the recipient throughout the process.

What cutting-edge technologies or techniques does the unit employ in urological surgeries?

The Urology and Transplant Unit, uses advanced technology to make surgeries safer and easier for patients. They perform keyhole surgeries using 3D laparoscopic systems and a robotic arm. This means they make only small cuts instead of big ones. Patients feel less pain, heal faster, and can go home sooner. They also have smaller scars and less chance of getting infections. SJGH is the only hospital in Sri Lanka that regularly uses this 3D technology for kidney donation surgeries. This helps the doctors see better and work more precisely when removing a kidney from a donor. The robotic arm adds even more accuracy to the surgeries. By using these modern tools, we can take better care of both kidney donors and the patients who receive new kidneys. They also perform Mini Percutaneous Nephrolithotomy (Mini PCNL) to treat kidney stones. This minimally invasive keyhole surgery uses a tiny 5 mm incision to access and remove kidney stones. Using advanced laser technology to break up the stones and extract them through this small opening. This technique offers patients less pain, quicker recovery times, and shorter hospital stays compared to traditional open surgery. The goal is to make complex surgeries safer and help patients recover quickly.

Why is it important that a kidney donor undergo laparoscopic surgery rather than open surgery?

It’s important to remember that a kidney donor is not a patient, but a healthy individual making a selfless gift of life to another person. For the donor, who gains no physical benefit from the surgery, minimising the impact of the procedure is paramount. The incision is solely for the surgeon to remove the kidney, and traditionally, larger donors require larger incisions. However, with laparoscopic techniques, the incision size is greatly reduced regardless of the donor’s body type.

The use of 3D laparoscopic technology further enhances the precision of the surgery. After surgery, donors often become ambassadors for living donation, sharing their positive experiences with others. Their message: “I feel good about kidney donation; it’s your chance to save a life,” can inspire others to consider this life-changing gift.

Are there any plans for expansion or new services in the Urology and Transplant Unit?

The Urology and Transplant Unit at SJGH has plans for expansion and new services to enhance patient care. One of the most significant upcoming developments is the introduction of simultaneous kidney-pancreas (SPK) transplantation in Sri Lanka, a first for the country. Two of the team members have received specialised training in Barcelona, Spain, to prepare for this groundbreaking procedure. SPK transplantation offers many benefits, especially for patients with type 1 diabetes and end-stage renal disease. It can eliminate the need for insulin injections and dialysis, improve quality of life, reduce the risk of diabetes-related complications, and potentially increase long-term survival rates compared to kidney transplantation alone. Additionally, they are exploring the future potential of robotic transplantation. This innovative approach could enhance precision during surgery, provide better visualisation for surgeons, allow for smaller incisions, and lead to faster recovery times. By adopting cutting-edge techniques and technologies, the Urology and Transplant Unit aims to stay at the forefront of transplant medicine in Sri Lanka, ensuring the best possible outcomes for their patients.

Why is it important to promote deceased organ donation in Sri Lanka?

Chronic kidney disease (CKD) has become a major health concern in Sri Lanka, silently affecting a large portion of the population. The number of people suffering from CKD is staggering 150,000 or more. What’s even more worrying is that about 20,000 of these cases are a mysterious type called CKD of unknown etiology (CKDu), where doctors can’t pinpoint the exact cause.

The impact of this disease is heartbreaking. Every year, around 3,000 families in Sri Lanka lose someone they love due to CKD-related problems. This isn’t just a health crisis; it’s a tragedy affecting thousands of homes across the country.

With so many people suffering from chronic kidney disease, doctors are working hard to find better treatments. While there are different ways to manage the condition, kidney transplants often give patients the best chance to get healthy again and enjoy life. The problem is that there aren’t enough donated kidneys for everyone who needs one. This means many sick people have to wait a long time for a transplant. The waiting lists are very long, and it’s tough for both the patients who are hoping for a new kidney and the doctors who want to help them. That’s why it’s so important to encourage more people to consider becoming organ donors.

SJGH has been a pioneer in promoting deceased organ donation in Sri Lanka. How has the hospital contributed to advancing this critical aspect of organ transplantation, and what notable achievements have been made in this area?

In response to this crisis, efforts are being made to increase awareness and promote organ donation. A dedicated website, www.odtfsrilanka.com has been developed to share inspiring organ donation stories, aiming to educate and inspire potential donors. The initiative emphasises that every citizen has the civic right to become an organ donor, potentially saving lives through this selfless act.

Looking ahead, there are plans to expand organ donation efforts beyond kidneys. The goal is to commence multi-organ donation, which could allow for saving up to eight lives through the donation of the heart, lungs, liver, pancreas, intestines, and kidneys from a single donor. This comprehensive approach to organ donation could significantly impact the lives of those waiting for transplants and their families.

SJGH established the country’s first donor memorial wall and organised the inaugural Organ Donor Walk in February 2018, which attracted over 3,000 participants and resulted in more than 2,000 new donor registrations. SJGH’s advocacy efforts led to 18 February being declared as National Organ Donor Day. In collaboration with the Ministry of Health, the hospital helped launch the National Organ Donor Card in 2021, creating a database of nearly 17,000 registered donors. By raising awareness, sharing stories, and expanding donation options, Sri Lanka is taking important steps to address the CKD epidemic and provide hope to thousands of affected individuals and their families.