MANHASSET, N.Y., Sept. 12 For the first time in medicalhistory, the transplant surgical team at North Shore University Hospital hasremoved the kidney of a donor through a single incision just above the pubicbone.
"One of the most revolutionary elements about this procedure is the factthat it reduces the donor's recovery time and leaves no visible scars," saidLouis Kavoussi, MD, chairman of urology at the North Shore-LIJ Health Systemand head of the Arthur Smith Institute of Urology in Lake Success, NY, who wasthe surgeon who recently performed the donor nephrectomy (removal of thekidney). The actual incision was less than two inches wide. Once healed, thepatient will not even see the scar.
In addition to Dr. Kavoussi, the transplant surgical included LeeRichstone, MD, chief of robotic and laparoscopic surgery at the SmithInstitute, and Ernesto Molmenti, MD, director of transplant surgery at NSUH.
This procedure came on the heels of a surgical milestone achieved by theCleveland Clinic, where doctors removed a kidney through a single incision ina patient's bellybutton. Dr. Kavoussi took the process one step further,making this procedure the first of its kind in the world. Two days after theprocedure, the patient was released from the hospital, with nary a scar toshow.
Dr. Kavoussi and his team have also been performing donor nephrectomiesthrough a single incision in the bellybutton. Decisions on whether to removethe kidney through the bellybutton or just above the pubic bone vary frompatient to patient. The former procedure is not appropriate for patients whohave had prior and/or major abdominal surgeries, or suffer from obesity.
The procedure involves making approximately a one or two-inch incisionjust above the pubic bone, in the interior of the bellybutton. A tube-likeport is then inserted -- one that contains several round entry points forinserting a camera and other tools into the belly.
The area is inflated with carbon dioxide to provide maneuvering room. Thekidney is then freed from connecting tissue, wrapped in a plastic bag andremoved through the navel (or through the incision above the public bone) whenthe blood supply is cut, shrinking the organ's fist-like size. The incision isexpanded to about 1 1/2 inches to extract the kidney after the port isremoved.
North Shore University Hospital is the only hospital in the world toperform the surgery using this technique. This surgical milestone, said Dr.Kavoussi, "really isn't about us. It's all about the patient. Donors are someof the most incredible and altruistic people that one meets. So, if we can dosomething to make it a little easier for the donors, why shouldn't we?"
Dr. Kavoussi was the first surgeon in the country to perform alaparoscopic donor nephrectomy when he was at John Hopkins Hospital inBaltimore, MD, in 1995.
SOURCE North Shore University Hospital