CLEVELAND(AP)
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 Cleveland Clinic doctors 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," Kaster, 29, said Wednesday. "I
can't even see it."
Kaster was the 10th donor to have the procedure done at the
Cleveland Clinic by Dr. Inderbir S. Gill and colleagues. The 11th
was done Thursday. Gill said the technique could make kidney
donations more palatable by sharply reducing recovery time.
More than 80,000 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, according to the Organ Procurement
and Transplantation Network.
The first 10 recipients and donors whose transplants used the
single-incision 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 procedure showed they recovered 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 recover.
The clinic says the return to work time for single-point donors
is about 17 days, versus 51 for traditional multi-incision
laparoscopic procedure.
"For me, that's huge so I can get back to work,"
said Kaster, a self-employed optometrist.
Patients of the new procedure were on pain pills less than four
days on average, compared with 26 days for laparoscopic
patients.
"This represents an advance, for the field of surgery in
general," said Gill, who predicted the bellybutton entry would
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. So anything you can do to make it better for that
patient, they deserve it," he said.
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 like the mouth, nose and vagina to perform
surgery.
The method used by the Cleveland Clinic takes advantage of the
belly button 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 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-author of an editorial in the journal, said the
method needs to be studied to determine if patients fare better.
"The reality is that nobody knows if this is an advance other
than cosmetic," said Kavoussi.
On Thursday, Scott Bolender, 39, of Washington Court House,
received a kidney taken from his niece, Chanda Calentine, by way of
her bellybutton.
"I'm just looking forward to getting out of bed,"
Bolender said in a bedside interview Wednesday.
Bolender, the married father of six children, has been unable to
work because 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 remaining kidney.
She also said she was confident in the promise of a "nearly
scar-free" post-surgical bellybutton but was prepared for the
alternative. "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 inserting 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 removed through the navel when the blood supply is
cut, shrinking the organ's fist-like size. The incision is
expanded to about 1 1/2 inches 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.
Kaster donated his kidney 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."
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Associated Press writers Joe Milicia in Cleveland and Stephanie
Nano in New York contributed to this report.
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On the Net:
Cleveland Clinic:
http://my.clevelandclinic.org
Organ Procurement and Transplantation Network:
http://www.optn.org
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