Cleveland Clinic taking kidneys through navel
By THOMAS J. SHEERAN
Associated Press Writer CLEVELAND, July 17,
2008 (AP): Brad Kaster donated a kidney to his fa- ther this week, and he barely has a scar to show for it.
The kidney was removed through a single incision in his bellybutton, a surgical procedure Cleveland Clinic doctors say will reduce re- covery time and leave al- most no scarring.
“The actual incision point on me is so tiny I’m not getting any pain from it,” Kaster, 29, said Wednesday. “I can’t even see it.”
Kaster was the 10th do- nor to undergo the proce- dure at the Cleveland Clinic. Dr. Inderbir S. Gill and colleagues at the re- search hospital on Thurs- day performed the 11th such procedure, which Gill said could make kidney donations more palatable by sharply reducing recov-
ery time. More
Americans are awaiting kidney transplants. Last year, there were about 13,300 kidney donors in the U.S., and about 45 percent were living donors, accord- ing to the Organ Procure- ment and Transplantation Network.
The first 10 recipients and donors whose trans- plants used the single-inci- sion navel procedure have done well, according to the researchers. They report on the first four patients in the August issue of the Journal of Urology.
Preliminary data from the first nine donors who had the bellybutton proce- dure showed they recov- ered in about just under a month, while donors who underwent the standard
laparoscopic procedure with four to six “key hole” incisions took just longer than three months to re- cover.
The clinic says the re- turn to work time for single-point donors is about 17 days, versus 51 for traditional multi-inci- sion laparoscopic proce- dure.
“For me, that’s huge so I can get back to work,” said Kaster, a self-employed optometrist.
Patients of the new pro- cedure were on pain pills less than four days on aver- age, compared with 26 days for laparoscopic patients.
“This represents an ad- vance, for the field of sur- gery in general,” said Gill, who predicted the bellybutton entry would be used increasingly for ma- jor abdominal surgery in a “nearly scar-free” way.
“Will this decrease the disincentive to (kidney) donation? I think the an- swer is yes,” Gill said.
Drs. Paul Curcillo and Stephanie King of Drexel University College of Medicine in Philadelphia developed a single-inci- sion technique and Curcillo was the first to use the method to remove a woman’s gallbladder through her bellybutton in May 2007. They’ve since used it for a number of dif- ferent kinds of surgery.
“will definitely make things better” for the donor. “A donor is one of the most altruistic people you’ll ever meet. He’s giving his kid- ney up. So anything you can do to make it better for that patient, they deserve it,” he said.
Laparoscopic surgery revolutionized the operat- ing room more than 15 years ago, replacing long inci- sions with small cuts and vastly reducing pain and recovery time. Researchers are now exploring ways to eliminate scars by putting instruments through the body’s natural openings like the mouth, nose and vagina to perform surgery.
The method used by the Cleveland Clinic takes ad- vantage of the belly button to avoid a visible scar. Gill said the procedure was ap- proved by the clinic’s in- ternal review board as an extension of its laparoscopic surgical work. He has begun train- ing other surgeons on the procedure. It is not used to transplant the kidney into the receiving patient.
Dr. Louis R. Kavoussi, head of the Arthur Smith Institute for Urology of the North Shore Long Island Jewish Health System in New York and the co-au- thor of an editorial in the journal, said the method needs to be studied to de- termine if patients fare bet- ter. “The reality is that no- body knows if this is an advance other than cos- metic,” said Kavoussi.
Scott Bolender, 39, of Washington Court House, received a kidney on Thurs- day from his niece, Chanda Calentine, by way of her bellybutton.
“I’m just looking for- ward to getting out of bed,” Bolender said in a bedside interview Wednesday.
Bolender, the married father of six children, has been unable to work be- cause of Wagner’s disease, an autoimmune disease that attacks the kidneys. He has
been undergoing lifesaving dialysis since 2005.
Calentine, 30, of New York City, said she was thrilled to provide a kidney for her good-natured uncle and that she expects to do fine with a single remain- ing kidney.
She also said she was confident in the promise of a “nearly scar-free” post- surgical bellybutton but was prepared for the alter- native. “A week ago I got a one-piece (bathing suit),” she said with a laugh.
The procedure involves making a three-quarter inch incision in the interior of the bellybutton and insert- ing a tube-like port with several round entry points for inserting a camera and other tools into the belly.
The belly is inflated with carbon dioxide to provide maneuvering room. The kidney is then freed from connecting tissue, wrapped in a plastic bag and re- moved through the navel when the blood supply is
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cut, shrinking the organ’s fist-like size. The incision is expanded to about 11/2 inches to extract the kid- ney after the port is re- moved.
The procedure would not be appropriate for those who have had multiple ma- jor abdominal surgeries or who are obese, Gill said. Both conditions would limit the ability to look around the abdomen and move about instruments.
Kaster donated his kid- ney to his father, Phil Kaster, 61, of Canal Fulton,
who was on dialysis for 10 months.
“When it’s family like that, you wouldn’t think twice,” he said. “I’m glad I’m able to give somebody their life back.”
Associated Press writers Joe Milicia in Cleveland and Stephanie Nano in New York contributed to this report. On the Net: Cleve- land Clinic: http:// my.clevelandclinic.org Organ Procurement and Transplantation Network: http://www.optn.org
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