A New, Less Invasive Technique for Kidney Donation

Surgeons at a leading US hospital are studying a new way to make kidney donation safer, less invasive and almost scar free for women by using a new technique that removes kidneys transvaginally.

The technique is called natural orifice translumenal endoscopic surgery (NOTES), in which surgeons use a natural opening in the body to minimize pain and scarring, making recovery much easier.

According to the United Network for Organ Sharing (UNOS), more than 60% of living kidney donors are female.

Currently, kidney donors undergo either open or minimally invasive laparoscopic surgery.  During the latter operation the surgeon prepares the kidney for removal by working through three ¼-inch incisions. However, when it comes time to remove the kidney, a larger three- to four-inch incision must still be made for the extraction. The larger incision is the source for most of the pain and scarring. Other complications of current surgical techniques include hernias and wound infection.

Removing the kidney transvaginally, where there are relatively few pain fibers, results in a nearly painless operation with no extraction scar.  The first procedure was performed, to media fanfare in February 2009 at Johns Hopkins University, in Baltimore, MD.  Although deemed a success, there was, at the time, considerable skepticism from other clinicians.

Now, a study is being undertaken at the Methodist Hospital in Houston, TX, which intends to examine some of these concerns.

The investigators will conduct a microbiological analysis of the cervix and vagina of patients undergoing laparoscopic transvaginal hysterectomy. A sterile mock kidney will be placed in the patient’s abdomen and extracted transvaginally at the end of the hysterectomy procedure. They will conduct a microbiological analysis of the mock kidney after the procedure, as well.

If this analysis shows no evidence of contamination, or other adverse effects, this technique may become a future standard, improving donor and recipient safety while reducing pain and recovery time for the donor.  Ultimately, it is hoped, it will also increase the number of donors.

According to UNOS there are, as of today, over 108,000 people in the US awaiting a transplant. For them, and their potential living donors, the results can probably not come soon enough.

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