Surgeons remove kidney through vagina
21 February 2009
In what is believed to be a first-ever procedure, surgeons at Johns
Hopkins University School of Medicine in the US have successfully
removed a healthy donor kidney through a small incision in the back of
the donor’s vagina.
“The kidney was successfully removed and transplanted into the
donor’s niece, and both patients are doing fine,” says Robert Montgomery
MD PhD, chief of the transplant division at Johns Hopkins University
School of Medicine who led the team that performed the historic
The transvaginal donor kidney extraction, performed on 29 January on
a 48-year-old woman from Lexington Park, Md., eliminated the need for a
5-to-6" abdominal incision and left only three pea-size scars on her
abdomen, one of which is hidden in her navel.
Transvaginal kidney removals have been done previously to remove
cancerous or nonfunctioning kidneys that endanger a patient’s health,
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,”
“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,” says Montgomery. “Removing the kidney through a natural
opening should hasten the patient’s recovery and provide a better
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.
The 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, according to Anthony
Kalloo, MD, the director of the Division of Gastroenterology at Johns
Hopkins University School of Medicine and the pioneer of NOTES. The most
common openings used are the mouth, anus and vagina.
Since 2004, successful NOTES in humans have removed diseased
gallbladders and appendixes through the mouth, and gallbladders, kidneys
and appendixes through the vagina.
Recently, Kalloo says, some medical experts have called for more
studies to compare the safety and effectiveness of NOTES against
traditional laparoscopies, which also leave very small scars, have been
in use for many years, and are proven to be safer and less painful for
patients than older “open” abdominal procedures. He supports more
But, 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.”
Additional surgeons from Johns Hopkins University School of Medicine
who participated in the procedure were Mohamad E. Allaf, M.D., assistant
professor in the departments of Urology and Biomedical Engineering and
director of minimally invasive and robotic surgery; Andy Singer, M.D.,
Ph.D., assistant professor in the Division of Transplant Surgery; and
Wen Shen, M.D., M.P.H., assistant professor in the Department of
Gynecology and Obstetrics.
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