In what is believed to be a first-ever procedure,
surgeons at Johns Hopkins 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," said Robert Montgomery, chief of the
transplant division at the Johns Hopkins
University School of Medicine, who led the team that
performed the historic operation.
The transvaginal donor kidney extraction, performed
Jan. 29 on a 48-year-old woman from
Lexington Park, Md., 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.
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, Montgomery said.
"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," Montgomery said. "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 said the surgery took about three and a
half hours, roughly the same as a
traditional laparoscopic procedure.
The Jan. 29 operation is one of a family of new
surgical procedures called natural orifice
translumenal endoscopic surgeries, known as NOTES, that use
a natural body opening to remove organs
and tissue, according to Anthony Kalloo, 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 said, 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 studies.
But, he added, "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, he said.
Additional surgeons from the Johns Hopkins University
School of Medicine who participated in
the procedure were Mohamad E. Allaf, assistant professor in
the departments of
Biomedical Engineering and director of minimally
invasive and robotic surgery; Andy Singer, assistant
professor in the Division
of Transplant Surgery; and Wen Shen, assistant
professor in the
of Gynecology and Obstetrics.