A woman is lying on the operating table. Her kidney is being removed for organ donation. The surgeon makes three cuts, each less than a centimeter long, in her abdomen. A couple hours later, her kidney is out, fully intact.
Wait a minute, you might be thinking. Is it physically possible to remove a kidney, which is about the size of your fist, through a hole the size of a pea? Well, it's not.
But there is a trick to this procedure. Although there were only three tiny external incisions made, the kidney was actually removed through the patient's vagina.
This procedure was performed for the first time ever at the Hopkins Hospital last month.
Similar procedures have been done in the past where the kidney was cancerous or diseased, but this is the first instance in which a kidney was removed healthy and fit for donation.
In general, a nephrectomy, or the surgery that removes one's kidney, is done using a method known as laparoscopy. The surgical instruments are introduced into the body through the three small incisions, and include an instrument for viewing the surgical area, like a video camera.
The other instruments physically separate the unwanted kidney tissue from the surrounding tissues.
Removing diseased tissue is slightly trickier. Sometimes the diseased kidney can be divided into several smaller pieces and removed from the existing incisions.
However, if the tissue is to be removed intact, a much larger incision, around 5 to 6 inches, must be made, leading to more pain, a longer recovery time and a not-so-sexy scar.
However, in the case of the organ transplant, they eliminated the need for a larger external scar by making an incision in the uterus of the patient after the healthy kidney had been dissected.
They then put the kidney in a bag, which is removed through the vagina. The vaginal incision is then closed, leaving the patient with only three visible cuts.
Not only does this procedure have significant cosmetic benefits, but it also causes less bleeding and post-operative pain, and has a much shorter recovery time because the largest incision is made inside the body where it is less susceptible to infection.
Furthermore, the incision made in the vagina is able to heal very well and is not as painful as an abdominal incision.
However, there are some drawbacks in performing the procedure laparoscopically. "The instruments that we use in laparoscopy, while sophisticated, do not have the degrees of freedom that the human hand has," said Mohamad Allaf, director of Minimally Invasive and Robotic Surgery at Hopkins, who led the surgical team for this procedure.
"Also, our instruments do not give us the ability to feel as well as we can with the human hand."
Nevertheless, with improvements in instrumentation technology, the future of laparoscopic surgery looks pretty bright. "We hope to be able to perform the entire procedure through the vagina without the use of any ports through the abdomen," Allaf said.
"This way, the patient will have absolutely no visible scars." These advances in kidney removal surgeries should also encourage more people to donate their kidneys.
