Cleveland Clinic First to Perform Successful Live Kidney Donation Through Single Belly Button Incision

Urologists Develop Scarless Kidney Removal, New Procedure Holds the Potential to Increase Living Don

Thursday, July 17, 2008, Cleveland: Family, friends and even altruistic strangers willing to donate a kidney now have a less invasive surgical option, called single-port trans-umbilical live donor nephrectomy.

The procedure, which entails removing a kidney via the belly button, has resulted in excellent kidney function in the recipient, according to Cleveland Clinic surgeons who will publish their findings in the August issue of the Journal of Urology. The new minimally invasive surgical alternative could benefit many of the more than 75,000 patients currently in need of a kidney in the United States.

 “We’re truly taking minimally invasive surgery to a new level with this procedure, and I can’t think of a more important use of this advancement than performing scar-free kidney removal in a healthy donor,” said Inderbir S. Gill, M.D., Chairman of Urology at Cleveland Clinic. “Kidney donors are truly giving the gift of life, so if we can make their surgery less daunting and less of an inconvenience while still maintaining the highest levels of safety and the best outcomes in the recipient we’re hopeful this will result in more people stepping forward to donate.”

Unlike traditional laparoscopic procedures that entail making four to six small “key-hole” incisions in the abdomen, Dr. Gill and his fellow urological surgeons can now harvest and remove the kidney in living donors through a single incision concealed within the belly button (umbilicus).  Outcomes from the initial cases show patients experience less pain, quicker recovery and have little-to-no visible scar.

In this new approach being performed only at Cleveland Clinic by Dr. Gill and his team, all aspects of kidney harvesting are performed through the navel, including removal. Initial steps include making a two-centimeter incision in the interior of the belly button, inserting a single port into the incision with multiple channels that will accommodate all surgical tools and the laparoscope, then inflating the abdomen with carbon dioxide to provide more room to work.  Once the kidney is freed, a pliable plastic bag is wrapped around the organ, its blood supply is disconnected, and the kidney is removed through the navel.

 “It is essential for a living kidney donation to be successful and safe because, unlike other surgeries that affect only one patient, there are two lives at stake during live transplantation.  The kidney has to be delicately removed to work perfectly in the recipient, so we have zero tolerance for errors,” said Dr. Gill, who has been one of the pioneers of laparoscopic urological surgery for the past decade.  “We’re continuing to document the outcomes of our single-port patients, but the initial reports and feedback are promising.”

In fact, initial data on the first nine cases performed by Dr. Gill and his team suggest the following outcomes reports in patients receiving single-port surgery versus traditional laparoscopic surgery for live donor nephrectomy:

 
Laparoscopic Patients
Single-Port Patients
Days on oral pain pills
26
3.7
Days until return to work
51
17
Days to 100% physical recovery
97
25

Dr. Gill is quick to note that these are initial data and that kidney donation through the belly button is not available to all patients.  Donors may not be eligible if they have had multiple major abdominal surgeries or are morbidly obese, as both conditions limit visibility and movement inside the abdomen.  Other members of the team include Drs. Monish Aron, David Canes, David Goldfarb, Mihir Desai, Jihad Kaouk, Stuart Flechner, and Venkatesh Krishnamurthy.

For more information on single-port trans-umbilical live donor nephrectomy, visit www.clevelandclinic.org/urology or call 216-444-5600.

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