Surgical technique boosts recovery after kidney donation

Brad Kaster donated a kidney to his father 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 that doctors at the Cleveland Clinic say will reduce recovery time and leave almost no scarring.

"The actual incision point on me is so tiny, I'm not getting any pain from it," said Kaster, 29. "I can't even see it."

Kaster was the 10th donor at the Cleveland research hospital to undergo the procedure, which was performed by Dr. Inderbir Gill and colleagues.

More than 80,000 Americans are awaiting kidney transplants. Last year, there were about 13,300 kidney donors in the United States, and about 45 per cent were living donors, according to the Organ Procurement and Transplantation Network.

Gill said the bellybutton surgery could make living kidney donations more palatable by sharply reducing recovery time.

The first 10 recipients and donors whose transplants used the single-incision navel procedure have done well, say the researchers, who 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 procedure show they recovered in less than a month, while donors who underwent the standard laparoscopic procedure with four to six "keyhole" incisions took more than three months to heal.

The clinic says the return-to-work time for single-point donors is about 17 days, versus 51 days for traditional multi-incision laparoscopic surgery.

"For me, that's huge, so I can get back to work," said Kaster, a self-employed optometrist.

Procedure may act as incentive to donate

Patients who had the new procedure were on pain pills less than four days on average, compared with 26 days for laparoscopy patients. "This represents an advance for the field of surgery in general," said Gill, who predicts the bellybutton entry will be used increasingly for major abdominal surgery in a "nearly scar-free" way.

"Will this decrease the disincentive to [kidney] donation? I think the answer is yes," Gill said.

Drs. Paul Curcillo and Stephanie King of Drexel University College of Medicine in Philadelphia developed a single-incision 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 different kinds of surgery.

Curcillo said the bellybutton procedure "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 kidney up," he said. "So anything you can do to make it better for that patient, they deserve it."

Laparoscopic surgery revolutionized the operating room more than 15 years ago, replacing long incisions 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, such as the mouth, nose and vagina, to perform surgery.

The method used by the Cleveland Clinic takes advantage of the bellybutton to avoid a visible scar. Gill said the procedure was approved by the clinic's internal review board as an extension of its laparoscopic surgical work. He has begun training other surgeons in the procedure. It is not used to transplant the kidney into the receiving patient.

The procedure involves making a two-centimetre incision in the interior of the bellybutton and inserting a tube-like port with several round entry points for inserting a camera and other tools into the abdomen.

The belly is inflated with carbon dioxide to provide manoeuvring room. The kidney is then freed from connecting tissue, wrapped in a plastic bag and removed through the navel when the blood supply is cut, shrinking the organ's fist-like size. The incision is expanded to about four centimetres to extract the kidney after the port is removed.

The procedure would not be appropriate for those who have had multiple major abdominal surgeries or who are obese, Gill said. Both conditions would limit the ability to look around the abdomen and move about instruments.