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NOTES Used for Kidney Donation


Believed to be a first-ever procedure, surgeons at Johns Hopkins have successfully removed a healthy donor kidney through the donor's vagina.

The transvaginal donor kidney removal was performed Jan. 29 on a 48-year-old Kimberly Johnson from Lexington Park, Md. By removing the donor kidney through a small incision in the back of her vagina, she was saved the need for a 5-to-6-inch abdominal incision. Instead she was left with only three pea-size scars on her abdomen, one of which is hidden in her navel.

Kimberley Johnson, who has three children said"It was easier than childbirth."

"The kidney was successfully removed and transplanted into the donor's niece (Jennifer Gilbert, 23), and both patients are doing fine," says Robert Montgomery, M.D., Ph.D., chief of the transplant division at Johns Hopkins University School of Medicine who led the team that performed the historic operation.

Transvaginal kidney removals have been done previously to remove cancerous or nonfunctioning kidneys, but not for healthy kidney donation. Transplant donor nephrectomies are the most common kidney removal surgery - 6,000 a year just in the United States.

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The first laparoscopic donor nephrectomy was performed at Johns Hopkins in 1995. It required a relatively large incision in the patient's abdomen after completing the nephrectomy to extract the donor kidney. The abdominal incision is thought to significantly add to the patient's pain, hospitalization and convalescence.

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.

The Jan. 29 transvaginal operation is one of a family of new surgical procedures called natural orifice translumenal endoscopic surgerie (NOTES) that use a natural body opening to remove organs and tissue. 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, 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.

The Associated Press
John Hopkins Medicine