Urologists Develop Scar-less Kidney Removal, New Procedure Holds the Potential to Increase Living Donations for Recipients in Need
7/17/08
Family, friends and even altruistic strangers willing to donate a kidney now have a less invasive surgical option, called single-port trans-umbilical live donor nephrectomy.
The procedure, which entails removing a kidney via the belly button, has resulted in excellent kidney function in the recipient, according to Cleveland Clinic surgeons who will publish their findings in the August issue of the Journal of Urology. The new minimally invasive surgical alternative could benefit many of the more than 75,000 patients currently in need of a kidney in the United States.
“We’re truly taking minimally invasive surgery to a new level with this procedure, and I can’t think of a more important use of this advancement than performing scar-free kidney removal in a healthy donor,” said Inderbir S. Gill, M.D., Chairman of Urology at Cleveland Clinic. “Kidney donors are truly giving the gift of life, so if we can make their surgery less daunting and less of an inconvenience while still maintaining the highest levels of safety and the best outcomes in the recipient, we’re hopeful this will result in more people stepping forward to donate.”
Unlike traditional laparoscopic procedures that entail making four to six small “key-hole” incisions in the abdomen, Dr. Gill and his fellow urological surgeons can now harvest and remove the kidney in living donors through a single incision concealed within the belly button (umbilicus). Outcomes from the initial cases show patients experience less pain, quicker recovery and have little-to-no visible scar.
In this new approach being performed only at Cleveland Clinic by Dr. Gill and his team, all aspects of kidney harvesting are performed through the navel, including removal. Initial steps include making a two-centimeter incision in the interior of the belly button, inserting a single port into the incision with multiple channels that will accommodate all surgical tools and the laparoscope, then inflating the abdomen with carbon dioxide to provide more room to work. Once the kidney is freed, a pliable plastic bag is wrapped around the organ, its blood supply is disconnected, and the kidney is removed through the navel.
“It is essential for a living kidney donation to be successful and safe because, unlike other surgeries that affect only one patient, there are two lives at stake during live transplantation. The kidney has to be delicately removed to work perfectly in the recipient, so we have zero tolerance for errors,” said Dr. Gill, who has been one of the pioneers of laparoscopic urological surgery for the past decade. “We’re continuing to document the outcomes of our single-port patients, but the initial reports and feedback are promising.”
In fact, initial data on the first nine cases performed by Dr. Gill and his team suggest the following outcomes reports in patients receiving single-port surgery versus traditional laparoscopic surgery for live donor nephrectomy:
Days on oral pain pills
Days until return to work
Days to 100% physical recovery
Single-Port Patients
3.7
17
25
Dr. Gill is quick to note that these are initial data and that kidney donation through the belly button is not available to all patients. Donors may not be eligible if they have had multiple major abdominal surgeries or are morbidly obese, as both conditions limit visibility and movement inside the abdomen. Other members of the team include Drs. Monish Aron, David Canes, David Goldfarb, Mihir Desai, Jihad Kaouk, Stuart Flechner, and Venkatesh Krishnamurthy.
For more information on single-port trans-umbilical live donor nephrectomy, visit www.clevelandclinic.org/urology or call 216.444.5600.
About the Glickman Urological and Kidney Institute
The Glickman Urological and Kidney Institute is one of 26 institutes at Cleveland Clinic that group multiple specialties together to provide collaborative, patient-centered care. The institute is a world leader in treating complex urologic and kidney conditions in adults and children, and U.S.News & World Report has ranked the urology program among the top two in the nation for nine consecutive years.
Institute physicians have pioneered medical advances including partial nephrectomy, laparoscopic and robotic urologic surgery, and the bioartificial kidney, while serving tens of thousands of patients annually. For more information on the Glickman Urological and Kidney Institute, visit www.clevelandclinic.org/urology.
About Cleveland Clinic
Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S.News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey.
Approximately 1,800 full-time salaried physicians and researchers at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2007, there were 3.5 million outpatient visits to Cleveland Clinic and 50,455 hospital admissions. Patients came for treatment from every state and from more than 80 countries. Cleveland Clinic’s website address is www.clevelandclinic.org.
Media Contacts
Megan Ferington Pruce, 216.445.7452
