Surgeons at The Johns Hopkins Hospital in Baltimore last month successfully removed a donor's healthy kidney through her vagina instead of through an incision in her abdomen. This is not the first time kidneys have been pulled from the body this way, but it is the first time such a procedure has been performed to remove a healthy organ.
The kidney was removed from Kimberly Johnson, 48, of Lexington Park, Md., who donated it to her ailing 23-year-old niece, according to the Associated Press. Johnson is among the first patients in the world to receive "natural orifice transluminal endoscopic surgery (NOTES)," a new procedure in which doctors remove organs and tissues through the body's natural openings—the mouth, the anus and the vagina—instead of via ones created in the skin by a surgeon's scalpel.
Mohamad Allaf, the urologist who performed the three-hour operation, says it went off without a hitch. Within minutes of extracting the kidney on January 29, another team of surgeons began the two-hour operation to transplant it into the recipient. Johnson was up and walking the same day—and released from the hospital the following morning. Allaf says she is "back to normal activity" and that the only restriction was a two-week ban on heavy lifting. (FYI: Her niece spent a few days in the hospital, which is typical after receiving a kidney transplant, and is also doing well, according to Allaf.) "It was easier than childbirth," Johnson, a mother of three, told the AP.
Does NOTES sound too good to be true? And if not, why isn't it used more often to spare patients the knife? We asked Wahid Wassef, a gastroenterologist at the University of Massachusetts Medical School in Worcester who has done extensive research on the procedure, to explain its pros and cons.
[An edited transcript of the interview follows.]
What is the advantage of removing an organ through the vagina, mouth or anus?
If you go through an orifice as opposed to an incision in the skin, the patient will have no scars. And the immune system appears to emerge stronger after these procedures compared to standard surgeries, which could result in fewer infections and faster healing. With no incision in the abdomen, you also eliminate the risk of hernias, which occur when part of the intestine pushes through the abdominal muscle. Let's say somebody has a gallbladder taken out the old-fashioned way; if it happens that one of the stitches in the abdominal muscle gives way, you have a weakness, and part of the intestine can push through that area forming a bulge under the skin. This is not an issue when no incisions are made in the abdomen.
How long have doctors been doing surgeries like this?
This procedure started about six years ago in humans; it had previously been done in animals.
How many times has the procedure been performed?
At least 15 procedures have been performed worldwide in addition to this one: this includes appendectomies (appendix removals) and cholecystectomies (gallbladder extractions) through the mouth and vagina.
How are kidneys usually removed?
Over the past 10 years or so, this has been done laparoscopically, which is a way of performing surgery using small openings. Doctors make two or three small incisions, each about a half inch, or the length of a staple, on the abdomen—usually one in the bellybutton, one a few inches above the bellybutton, and another a few inches to the side of the bellybutton. Through these incisions, they insert rigid plastic tubes or "ports," which are used to guide surgical instruments and scopes, or cameras, into the body. The scope allows you to visualize what you are doing; you have television monitors in the operating room that magnify images from inside the body by 10 or 20 times. A larger incision about six inches (15 centimeters) long is then made several inches below the belly button, and this is where the kidney is pulled out.