“The kidney was successfully removed and transplanted into the donor’s niece, and both patients are doing fine,” said Robert Montgomery, MD, PhD, chief of the transplant division at Johns Hopkins University School of Medicine who led the team that performed the historic operation, according to press release issued by the institution. [break]
The transvaginal donor kidney extraction, performed January 29 on a 48-year-old woman from Lexington Park, Maryland, US, 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 novel surgery was performed by Mohamad E Allaf, MD, assistant professor in the departments of Urology and Biomedical Engineering and director of minimally invasive and robotic surgery.
“In contrast to removing diseased kidneys, this procedure has to deliver a perfect kidney since it will be used by the recipient,” said Allaf.
Cancerous or nonfunctioning kidneys that endanger a patient’s health had been removed through vagina before, but not for healthy kidney 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,” said 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.
Montgomery added that removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result.
Both laparoscopies and transvaginal operations are enabled by wandlike cameras and tools inserted through small incisions. In the transvaginal nephrectomy, two wandlike tools pass through small incisions in the abdomen and a third flexible tool housing a camera is placed in the navel.
Video images displayed on monitors guide surgeons’ movements. Once the kidney is cut from its attachments to the abdominal wall and arteries and veins are stapled shut, 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 says the surgery took about three and a half hours, roughly the same as a traditional laparoscopic procedure.
Since 2004, diseased gallbladders and appendixes have been through the mouth, and gallbladders, kidneys and appendixes through the vagina.
The press release said that the January 29 operation is one of a family of new surgical procedures called natural orifice translumenal endoscopic surgeries (NOTES) that use a natural body opening to remove organs and tissue. The most common openings used are the mouth, anus and vagina.
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