In what is believed to be a world first, transplant surgeons in the US have successfully removed a healthy kidney through a small incision in the back of the 48-yearl old donor’s vagina and transplanted it into her niece.
Removal of cancerous and defective kidneys through the vagina has been done before, but this is thought to be the first time a healthy kidney has been removed this way, the news of which may encourage more people to donate as it gives another option that is minimally invasive.
The operation took place last Thursday, the 29th January at the Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr Robert Montgomery, chief of the transplant division at the School led the surgery, he said on Monday that:
“The kidney was successfully removed and transplanted into the donor’s niece, and both patients are doing fine.”
Removing the kidney through the vagina, avoided the need to make a 5 to 6 inch incision in the donor’s abdomen. In fact it only left three pea-size scars on her abdomen, one of which is hidden in the navel.
Dr Mohamad E Allaf carried out the novel surgery. He is assistant professor in the departments of Urology and Biomedical Engineering and director of minimally invasive and robotic surgery at Johns Hopkins.
Allaf has removed a diseased kidney through the vagina before, but this was the first time that he has removed a healthy one from a kidney donor.
The difference between the two procedures is obvious: when you remove a diseased kidney, there is no need to worry about damaging it or exposing it to infectious agents. But when you remove a healthy one, you have to “deliver a perfect kidney since it will be used by the recipient”, explained Allaf.
Removal of kidneys for transplant are the most common reason that kidneys are surgically removed. There are at least 6,000 such operations a year in the US alone. This new approach could have a:
“Tremendous impact on people’s willingness to donate by offering more surgical options,” said Montgomery.
Removing the kidney through the abdomen by laparoscopy requires an abdominal incision that many doctors believe adds to the patient’s pain, as well as their hospitalization and convalescence.
“Removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result,” said Montgomery.
For the operation, surgeons inserted two “wandlike” tools into the abdomen via small incisions, and a third flexible tool containing a camera through a small incision in the navel. This gave them a visual image so they could control the tools.
Once the kidney is cut away from the abdominal wall and arteries and veins are closed off with staples, the surgeons put the kidney in a plastic bag that went in through an incision in the wall of the back of the vagina and pulled it out again, with the kidney inside, using a string attached to the bag.
The vaginal operation took about three and a half hours, about the same time as the traditional laparoscopic method.
However, some doctors are concerned about the safety of such a procedure.
Dr Jihad Kaouk, director of laparoscopic and robotic surgery at the Cleveland Clinic told CNN News that delivering a kidney via the vagina, a non-sterile environment, could introduce a new risk.
“The tube touched the vagina. And the bag touched the tube. And the bag touched the kidney,” he said, explaining that because the kidney will have been squeezed, it may also have been damaged.
“The concept of minimizing incisions and decreasing pain after surgery is always a good idea, but we should always check at what price,” he told CNN.
The novel procedure is one of a family of new approaches called NOTES, natural orifice translumenal endoscopic surgeries, that use a natural opening in the body as an access way to remove organs and tissue. The most common orifices used in such surgeries are the mouth, anus and vagina, said Dr Anthony Kalloo, the director of the Division of Gastroenterology at Johns Hopkins and the pioneer of NOTES.
Kalloo said there is a need for more studies to compare the safety and effectiveness of NOTES versus traditional methods.
“Natural orifice translumenal endoscopic surgery is the final frontier to explore in making surgery scarless, less painful and for obese patients, much safer,” said Kalloo.
“An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure,” he added.
Sources: Johns Hopkins University School of Medicine, CNN News.
Written by: Catharine Paddock, PhD