Urology

An Easier Kidney Donation

Mohamad Allaf's procedure is one of a family of new
operations called NOTES-natural orifice translumenal
endoscopic surgeries.

As an expert in both minimally invasive urological surgery and biomedical engineering, Mohamad Allaf already knew a thing or two about how to extract a human kidney through a patient’s vaginal canal. He and a few others have done it multiple times with kidneys that were cancerous or otherwise diseased.

But his case on January 29 presented an entirely new challenge. This time, it was a healthy donor kidney intended for immediate transplant. Allaf, who directs minimally invasive and robotic surgery here, had practiced the novel technique for months using animal models. Now his goal was to remove a human organ through the vaginal canal in such a way that it would emerge in perfect condition, untouched by any of the normal bacteria that dwell in a structure with external exposure. If all went according to plan, it would be the first successful transplant of a kidney removed through the vagina.

The donor, 48-year-old sales manager Kimberly Johnson, had previously undergone a hysterectomy, which meant fewer natural obstacles for Allaf. For Johnson, the advantage of the new approach was obvious. She’d be spared the five-centimeter abdominal scar offered by the usual laparoscopic technique, along with weeks of pain and compromised activity. She’d also be able to help out her sick 23-year-old niece.

“This is just an access technique,” Allaf says, explaining that the goal is to reduce the donor’s trauma while ensuring no compromise of any kind in outcomes for the recipient.

To do the procedure, Allaf used a “hybrid technique” in which a lighted endoscope and surgical wands were introduced through a small incision through Johnson’s navel. At the same time, another member of the surgical team inserted a sponge-tipped stick up through the vagina and pressed it against the organ’s back wall as a visual cue for Allaf to make a small incision for access into the vaginal canal.

Next, Allaf identified the healthy kidney and snipped away its connective vessels, then slipped it into an impermeable, sealable plastic pouch within the operational cavity. Once the pouch was sealed up with the clean donor kidney safely enclosed, an assistant with a string attached to the bag retrieved it through the small opening in mere seconds.

The elapsed time between snipping the kidney’s blood vessels and flushing it with a preservative solution is important for the organ to maintain its maximum viability. Allaf says the usual time for traditional laproscopic nephrectomy is about four minutes. With the transvaginal approach, this detail unfolded in less than three minutes. “That’s an added bonus,” he smiles.

Allaf was then able to suture the vaginal wall’s small incision from the inside. The transplant was a success, and Johnson was able to go home the next day, comparing her level of surgical discomfort to that of a tooth extraction.

The introduction of laparoscopic techniques for removing kidneys has tripled donations in the United States to 6,000 as of last year—important since some 60,000 Americans remain on the waiting list for a kidney.  From the early indications of interest, Allaf expects this breakthrough to bring forward donors in even greater numbers. He says the transplant team has taken calls from places like California and Texas.

Hoping to broaden the applications of the transvaginal extraction, Allaf is exploring ways to perform the procedure without introducing surgical instruments through the navel. “The goal,” he says, “is to do the entire thing transvaginally.”

To discuss a case or refer a patient call +1.443.287.6499.

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