By Matthew Brady 
Cardiac surgeon Dr. Feras Khaliel, who led a team at King Faisal Specialist Hospital and Research Centre in Riyadh, Saudi Arabia, to perform the world’s first fully robotic heart transplant, discusses in an interview with HealthTechAsia how KFSHRC is poised to push the boundaries of cardiac and surgical care.
In September 2024, a medical team led by Saudi cardiac surgeon, Dr. Feras Khaliel, Head of Cardiac Surgery and Director of the Robotics and Minimally Invasive Surgery Program at KFSHRC in Riyadh, performed a world first – a fully robotic heart transplant on a 16 year old patient.
The team used the da Vinci Surgical System, a platform with robotic arms and high-definition 3D visualisation, allowing it to perform the transplant without opening the patient’s chest. Instead, the heart was accessed by the robotic surgical system through small incisions, with the aim of reducing trauma and the risks typically associated with open-heart surgery.
The entire surgery was completed in just two and a half hours, compared with the 6 to 12 hours typically required for a traditional heart transplant, demonstrating the efficiency of the surgical technique.
Crucially, AI analytics were integrated with the da Vinci Surgical System, Dr. Feras revealed, enhancing real-time decision-making and allowing for precise adjustments during the delicate procedure, ultimately contributing to superior patient outcomes and an expedited recovery process.
“We aimed to achieve a level of precision that traditional surgery could not match, enabling us to perform a minimally invasive transplant without a full chest incision and reducing risks, complications, and recovery times. Our ‘Khaliel Technique’, making it particularly suitable for operations requiring high accuracy and reduced patient trauma, is now patented in the US,” the surgeon said.
Preparation with robotic precision
The procedure was the latest and most advanced in KFSHRC’s robotic surgery programme, which has seen over 1,195 robotic-assisted surgeries performed across different specialities, including the world’s first fully robotic liver transplant, and 400 robotic cardiac procedures.
“Our robotic surgery programme aims to enhance the patient experience by maximising safety and efficiency. Patients experience smoother recoveries, enhanced mobility, and an overall improvement in quality of life,’ Dr. Feras emphasised, highlighting the reduced risk of complications such as infections and excessive bleeding.
“Hospital stays for robotic valve surgeries are reduced to 6.8 days, compared to 10.4 days for traditional methods, and mechanical ventilation times are significantly shorter: 4.8 hours versus 10.9 hours for conventional sternotomy procedures.”
The 16-year-old patient operated on by Dr. Feras and his team suffered from end-stage heart failure and faced significant challenges, making traditional open-heart surgery a far more traumatic option and aligning well with the requirements for a robotic transplant.
Yet a robotic transplant was also not without its risks. Dr. Feras highlighted the challenge of implementing AI in the operating room, emphasising the need for seamless integration with existing workflows. “The procedure required perfect synchronisation between human expertise and AI systems, especially given the need for compatibility across various technologies.”
Roles were meticulously defined ahead of the surgery and specialised training was provided for each team member to ensure effective coordination. Weeks of detailed theoretical planning and several rounds of virtual simulations followed.
“Our team practised the procedure seven times over three consecutive days – which helped us refine every aspect of the surgery and anticipate potential challenges,” said Dr. Feras.
“As a cardiac surgeon, I was convinced to proceed due to the transformative potential of robotics in surgery, especially after our success in performing the world’s first robotic liver transplant,” he added. “I saw an opportunity to push the limits of cardiac care, significantly improving the quality of life for the patient.”
The team’s comprehensive planning and expertise was welcomed by the patient and their family, who made the decision to proceed collaboratively with the team upon detailed preoperative evaluations of the patient. “They trusted our approach that focused on the best outcome for the patient,” Dr. Feras said.
“Ultimately, our intensive preparation minimised risks, optimised the 2.5-hour surgery, and allowed us to deliver a successful outcome with enhanced precision and safety.”
AI-driven robotic surgery and human empathy
The future looks exciting for robotic surgery in the operating theatre, especially in Saudi Arabia, Dr. Feras believes, owing to its success in cases requiring accuracy and minimal invasiveness, resulting in improved patient outcomes and expanded access to advanced surgical care.
While robotic surgery will continue to be used in complex cardiac procedures, its application is also expanding to other areas – such as organ transplants, oncology, and paediatric surgeries, where precision and minimally invasive techniques are critical.
“Procedures like multi-valve operations, aortic valve replacements, and high-risk organ transplants are ideal candidates for robotic intervention, thanks to the reduced physical trauma and faster recovery times that robotics provide,” Dr. Feras explained.
He believes that increased robotic autonomy could allow the system to perform repetitive or precision-demanding tasks more efficiently, enhancing the surgeon’s control over every detail, even in the most complex procedures.
The next decade in particular will see AI transform the dynamics of the operating room, working in collaboration with the surgeon. “AI will increasingly serve as a real-time partner, providing predictive insights, suggesting optimal surgical pathways, and enhancing precision,” Dr. Feras said. “It will handle the data, while surgeons bring the empathy, adaptability, and expertise that are crucial in complex situations. This evolving partnership will make surgeries safer, faster, and more personalised, genuinely changing how we approach patient care.”
Ultra-fast connectivity that includes 6G will furthermore enable seamless remote surgeries, allowing surgeons to operate and collaborate in real-time with global experts from anywhere in the world without limitations.
“At KFSHRC, we’ve already witnessed the transformative power of AI in mechanical circulatory support and robotic-assisted surgeries, in significantly reduced recovery times and better patient outcomes,” Dr. Feras concluded. “The convergence of AI, 6G, and robotics will make surgeries more efficient, safer, and accessible, ultimately reshaping healthcare delivery worldwide.”