American doctors at Johns Hopkins have for the first time removed a healthy kidney from a donor through a minimally invasive method, which involved a small incision in the back of her vagina.
The transvaginal donor kidney extraction was performed on a 48-year-old woman from Lexington Park, Maryland, on January 29.
The surgeons behind it said that the procedure eliminated the need for a 5-to-6-inch abdominal incision, and left only three pea-size scars on her abdomen, one of which is hidden in her navel.
"The kidney was successfully removed and transplanted into the donor's niece, and both patients are doing fine," says Dr. Robert Montgomery, chief of the transplant division at Johns Hopkins University School of Medicine who led the team that performed the historic operation.
Although transvaginal kidney removals have been done previously to remove cancerous or non-functioning kidneys that endanger a patient's health, this is the first time that a healthy kidney has been removed with this method for the purpose of donation.
"Because transplant donor nephrectomies are the most common kidney removal surgery - 6,000 a year just in the United States - this approach could have a tremendous impact on people's willingness to donate by offering more surgical options," says Montgomery.
"Since the first laparoscopic donor nephrectomy was performed at Johns Hopkins in 1995, surgeons have been troubled by the need to make a relatively large incision in the patient's abdomen after completing the nephrectomy to extract the donor kidney. That incision is thought to significantly add to the patient's pain, hospitalization and convalescence. Removing the kidney through a natural opening should hasten the patient's recovery and provide a better cosmetic result," adds Montgomery.
Both laparoscopies and transvaginal operations are enabled by wandlike cameras, and tools inserted through small incisions.
The transvaginal nephrectomy operation involves two wandlike tools that pass through small incisions in the abdomen, and a third flexible tool housing a camera, which is placed in the navel.
Video images displayed on monitors guide surgeons' movements.
After the kidney is cut from its attachments to the abdominal wall and arteries and veins are stapled shut, the surgeons place the kidney in a plastic bag inserted through an incision in the vaginal wall and pull it out through the vaginal opening with a string attached to the bag.
Montgomery has revealed that the surgery completes in about three and a half hours, roughly the same time as is taken to perform a traditional laparoscopic procedure.
Dr. Anthony Kalloo, the director of the Division of Gastroenterology at Johns Hopkins University School of Medicine, has revealed that the operation conducted on January 29 was one of a family of new surgical procedures called natural orifice translumenal endoscopic surgeries (NOTES), which use a natural body opening to remove organs and tissue.
The pioneer of NOTES has also revealed that the most common openings used are the mouth, anus and vagina.
He adds: "Natural orifice translumenal endoscopic surgery is the final frontier to explore in making surgery scarless, less painful and for obese patients, much safer. An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure."