Taking another step down the path toward minimally invasive surgery, doctors at Johns Hopkins announced yesterday that they have removed a woman's kidney through her vagina, eliminating the need for a painful 5-inch abdominal scar. It marked the first time that a kidney destined for donation has been removed in this manner, officials said.
"Isn't it wild?" said Dr. Robert Montgomery, chief of the transplant division at the Johns Hopkins University School of Medicine. "We're trying to make this operation as pain-free and as convenient as possible for the donor so more people will donate."
To perform the 3 1/2 -hour surgery, doctors made three small incisions in the belly - one in the navel and two others - large enough for a camera and small flexible tools to be inserted into.
Typically, after a donor kidney is disconnected, surgeons will then make a larger cut in the abdomen to extract the fist-size organ.
In this case, surgeons cut a hole in the vaginal wall and basically sent the kidney out through the birth canal, encased in an impenetrable plastic bag. The surgery was simplified because the patient had previously undergone a hysterectomy.
The surgery took place Thursday, when Kimberly Johnson, 48, a sales manager from St. Mary's County, donated her right kidney to her niece, Jennifer Gilbert, 23. Johnson was able to leave the hospital after 24 hours, as opposed to the more typical two to three days. She said the pain she felt yesterday - four days after surgery - was "no worse than getting a tooth pulled." The kidney is functioning well in her niece, Johnson said.
Kidney donations have tripled since the laparoscopic procedure became available to donors, to about 6,000 a year in the United States.
"It is a courageous step into the future," said Dr. Jihad Kaouk, a Cleveland Clinic urologist who was among a group who recently pioneered the extraction of donor kidneys through a single incision in the navel. But he worries about the increased risk of infection to a kidney that travels through the vagina, a kidney that will be implanted in a person whose immune system will be suppressed.
"We need to be careful of what kind of kidney we are delivering," he said.