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Faculty Surgeons Perform Novel Scarless, Single-Port Surgery Through the Navel of Kidney Donor

Thursday, April 23, 2009

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 Kristen McLoughlin with the woman whose life she saved, Cynthia Jacobson.
 

University of Maryland Medical Center is only the third hospital in United States to offer new procedure, which patient calls a “breakthrough for future donors”

The University of Maryland Medical Center in Baltimore is the first hospital in Maryland and only the third in the United States to perform a single-port, natural orifice kidney removal surgery through the navel for a living kidney donor. During the procedure, surgeons use a single opening in the navel (belly button) as they manipulate a camera and two laparoscopic instruments to separate the kidney from its attachments in the abdomen. The kidney is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.

"This is the next advance in organ donation and we are pleased to be able to offer this procedure to patients who are doing a very altruistic thing by donating a kidney. It is another way we can say thanks to the very special people who are organ donors," says Rolf Barth, M.D., a transplant surgeon at the University of Maryland Medical Center and assistant professor of surgery at the University of Maryland School of Medicine. Dr. Barth led the surgical team as they performed the single-incision kidney removal on April 15, 2009. He adds, "Most kidney donors would qualify for this new approach."

Kristen McLoughlin, 22, of Madison Heights, Va., was the first kidney donor to undergo the single-port, kidney removal through the navel at the University of Maryland Medical Center. Ms. McLoughlin has high praise for this advance. "It’s neat. I came out of surgery with just a Band-Aid. It’s a breakthrough for future donors and will make it easier for them," she says.

Laparoscopic removal of donor kidneys, which University of Maryland Medical Center surgeons have performed since March 1996, has become the norm. That approach requires three or four tiny openings in the abdomen to insert a camera and instruments, and a four-inch incision to lift out the kidney. However, the new procedure, called single-incision laparoscopic surgery, accomplishes everything through a single opening in the belly button.

Single-incision laparoscopic kidney removal employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.

"The single incision is the next step in promoting safe organ donation," says Benjamin Philosophe, M.D., Ph.D., director, division of transplantation at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine, who participated in this landmark surgery. "The traditional laparoscopic approach has a long track record of minimal risk and quick recovery, but it is likely that the single-port technique will be even better since there is only one small incision."

Ms. McLoughlin donated her kidney to 54-year-old Cynthia Jacobson of Timonium, Md. Ms. Jacobson had been waiting for a kidney for a year and a half. She met Ms. McLoughlin through a Web-based organ donor matching service, matchingdonors.com.

Because of Ms. Jacobson’s polycystic kidney disease, her enlarged, diseased kidneys had to be removed. The University of Maryland Medical Center specializes in helping patients with Ms. Jacobson’s condition by removing the diseased kidneys just before the transplant, in one operation.

Andrew C. Kramer, M.D., urologist at the University of Maryland Medical Center and assistant professor of surgery at the University of Maryland School of Medicine, led the team that removed the kidneys. The transplant team was led by Eugene J. Schweitzer, M.D., transplant surgeon at the University of Maryland Medical Center and professor of surgery, University of Maryland School of Medicine.

Ms. McLoughlin says she began thinking about becoming an organ donor after her older sister was killed in a car accident more than three years ago. Some of her sister’s organs were donated after her death, and that started Ms. McLoughlin thinking about the idea of organ donation.

Ms. McLoughlin says that becoming an organ donor fits in with her work helping others that she’s been involved in during the past year after graduating from college. She is co-chair of a domestic violence coalition and a victim services coordinator in Lynchburg, Va., with the Crisis Line of Central Virginia, where she assists people who were victims of rape or sexual assault. She also teaches self-defense classes for college-age women and conducts courses at the local police academy about interviewing victims of sexual assault.

"The decision to use the single-port technique is consistent with the research and educational philosophy at the University of Maryland School of Medicine, which nurtures the quest for innovative ways to improve patient care," says E. Albert Reece, M.D., Ph.D., M.B.A., Vice President for Medical Affairs, University of Maryland; John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine.

"University of Maryland Medical Center surgeons have always been leaders in minimally invasive surgery," says Jeffrey A. Rivest, President and Chief Executive Officer of the University of Maryland Medical Center. "This procedure signals another step forward for our nationally acclaimed transplant program and elevates our efforts to provide the best surgical care while improving patient recovery."

Dr. Barth says that for donors like Kristen McLoughlin, who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.

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Bill Seiler
Media Relations
410-328-8919
bseiler@umm.edu

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 Dr. Rolf Barth led the surgical team that performed the single-incision kidney removal.