Small Scars for a Big Gift

Kidney transplants made easier for living donors through minimally invasive surgical techniques

(RxWiki News) Kidney transplants usually have a better chance of surviving if the organ comes from a living donor. With the number of living donor transplants on the rise, researchers are looking for ways to make the surgery easier on donors.

Spanish researchers have found that a certain surgical technique for removing a kidney leaves only very small scars.

"Living kidney donors can worry less about scarring."

Antonio Alcaraz, M.D., Ph.D., an investigator at the Institut d'Investigacions Biomèdiques August Pi i Sunyer and head of the urology department at the Hospital Clínic of Barcelona, and his colleagues showed that a surgical technique called NOTES (natural orifice transluminal endoscopy surgery) is a practical way to remove kidneys from living donors. NOTES is an approach in which a surgery is done through natural openings in the body.

Dr. Alcaraz's team used the transvaginal (through the vagina) and transumbilical (through the belly button) techniques to remove kidneys for transplantation from living donors. Both techniques leave small scars of about 0.20 inches and 0.39 inches.

This minimally invasive approach to removing kidneys from living donors has many benefits, says Dr. Alcaraz. The technique not only causes less scaring, but also leads to a better quality of life for the donor, a shorter stay in the hospital, and less pain.

The surgery is easily repeated, Dr. Alcaraz continues, and may raise the amount of living donors among women.

Living donor transplants are the best for young people and those with certain conditions. According to Dr. Rafael Matesanz, director of Spain's National Transplant Organization, it is important to continue working on this surgical technique to make it better. Improving the technique is the best chance for children and young patients with diabetes or kidney failure - patients who need a kidney as soon as possible.

"Just as the switch from surgeons primarily performing open nephrectomies to performing laparoscopic nephrectomies made it easier on the donors, the types of surgery mentioned here may someday be perfected and become the norm," says Laurie Reece, Executive Director of The Alliance for Paired Donation, a national organization that facilitates kidney transplants for incompatible donor-recipient pairs, and Texas Transplantation Society, a group of transplant physicians, surgeons, nurses and others who work in the field of organ or bone marrow transplantation. 

Reece continues, "It's well documented that kidneys from living donors outlast deceased donor kidneys, so anything we can do to make the surgery safer and less invasive and yield a quicker recovery for donors would be a boon."

For their research - which is published in the journal European Urology - Dr. Alcaraz and his team operated on 30 women using the NOTES technique. They also operated on four men using a method called LESS (laparoscopic-endoscopic single-site surgery).

In women, the surgery (called transvaginal nephrectomy) involves two pathways: one in the vagina and one in the abdomen. It leaves two scars in the abdomen of about 0.20 inches and 0.39 inches. In men, the surgery (called single-port nephrectomy) involves just one pathway through the belly button.

These techniques are a huge step forward in kidney transplant surgery, says Dr. Roser Deulofeu, Director of the Catalan Transplant Organization. They will reduce the amount of physical injury to living donors and make the recovery process easier to handle.  

Review Date: 
August 5, 2011