Friday, July 18, 2008

Single Incision Kidney Harvest

Transplant surgeons at the Cleveland Clinic (i.e. the Evil Empire) are starting to perform donor nephrectomies through the new technique of single port laparoscopy. Generally, laparoscopic surgery is done via multiple tiny incisions for multiple ports; one for the camera, one for the retractors, one for the tools, etc. Single port access involves making one incision by the umbilicus through which a multi-holed port is placed. As a result, you are left with a single, small, unobtrusive scar deep in the folds of the belly button.

As far as I'm concerned, this is the next stage of minimally invasive surgery. Incisionless surgery (NOTES), on the other hand, is not the way of the future. Imagine presenting a hypothetical patient with the two options:

Option 1: Guess what Mrs. Y? I can slash a hole in your vagina, reach inside and wrench out your gallbladder! Isn't it cool that I can do that? Here, sign this consent form.

Option 2: You need your gallbladder out Mrs Y. To do so, I need to make a very small cut in the folds of your belly button through which all my tools and camera will enter your abdominal cavity. You'll go home the same day and have very little post-operative pain.

Obviously I'm being just a wee bit disingenuous, but the fact remains that most female patients requiring cholecystectomy or appendectomy or Gyne procedures are of child bearing age. I just don't see NOTES taking off when you have to get women to wrap their minds around the idea of having an intentional injury created in the vagina. Plus, it requires teaching thousands of surgeons an entirely new technique, whereas single port laparoscopy utilizes existing technical knowledge....

Anyway, This Dr Gill at the Cleveland Clinic has now done 11 donor nephrectomies via the single port technique, with good results so far. So if you're looking to put a kidney on the open market, make an appointment with this guy. Just think twice about having any kind of orthopedic intevention down there, especially if you're a professional athlete on the Cleveland Browns....

6 comments:

ER's Mom said...

And a bit of surgical history...gyns USED to do tubal ligations via an incision in the vagina. Evidently it hurt a lot post-operatively. Notice how most tubals are done laparoscopically nowadays. We went AWAY from using the vagina as a way to hide incisions for things like that.

Although one attending where I trained would do them transvaginally.

Cathy said...

I just realized that you are no longer anonymous. I think you made a wise decision.

rlbates said...

Can I still call you Buckeye?

make mine trauma said...

First, nice picture. Second, there is nothing in my abdomen that needs to be anywhere near my vagina or my mouth. And third, do you just get jacked up on more prophylactic antibiotics for a NOTES procedure? Whether it's vaginal or oral, there are things living there that I certainly wouldn't want introduced into the abdomen.

Devorrah said...

I'd rather have the image in my mind of a surgeon bending to his work over my tummy than my vagina.

Anonymous said...

My gynecologist did a laparoscopic tubal ligation for me via a tiny incision in my belly-button -- in 1970. He did this eight hours after my baby was born. I experienced no pain, no complications. For a long time I could see the tiny scar, but it has long since completely disappeared. Was he ahead of his time? He was the best gynecologist in the world, in any case.