A new twist on the kidney transplant

HOPKINS TRANSPLANT SURGEONS REMOVE HEALTHY KIDNEY THROUGH DONOR’S VAGINA

Minimally invasive organ removal could increase donations, surgeons sayFebruary 2, 2009- In what is believed to be a first-ever procedure, surgeons at Johns Hopkins have successfully removed a healthy donor kidney through a small incision in the back of the donor’s vagina.“The kidney was successfully removed and transplanted into the donor’s niece, and both patients are doing fine,” says Robert Montgomery, M.D., Ph.D., chief of the transplant division at Johns Hopkins University School of Medicine who led the team that performed the historic operation.The transvaginal donor kidney extraction, performed Jan. 29 on a 48-year-old woman from Lexington Park, Md., eliminated the need for a 5-to-6-inch abdominal incision and left only three pea-size scars on her abdomen, one of which is hidden in her navel.The novel surgery was performed by Mohamad E. Allaf, M.D., assistant professor in the departments of Urology and Biomedical Engineering and director of minimally invasive and robotic surgery. Allaf has performed a previous transvaginal nephrectomy on a diseased kidney, but this was the first time he has operated on a kidney donor.“In contrast to removing diseased kidneys, this procedure has to deliver a perfect kidney since it will be used by the recipient,” says Allaf.Transvaginal kidney removals have been done previously to remove cancerous or nonfunctioning kidneys that endanger a patient’s health, but not for healthy kidney donation. Because transplant donor nephrectomies are the most common kidney removal surgery — 6,000 a year just in the United States — this approach could have a tremendous impact on people’s willingness to donate by offering more surgical options,” says Montgomery.“Since the first laparoscopic donor nephrectomy was performed at Johns Hopkins in 1995, surgeons have been troubled by the need to make a relatively large incision in the patient’s abdomen after completing the nephrectomy to extract the donor kidney. “That incision is thought to significantly add to the patient’s pain, hospitalization and convalescence,” says Montgomery. “Removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result.”Both laparoscopies and transvaginal operations are enabled by wandlike cameras and tools inserted through small incisions. In the transvaginal nephrectomy, two wandlike tools pass through small incisions in the abdomen and a third flexible tool housing a camera is placed in the navel.Video images displayed on monitors guide surgeons’ movements. Once the kidney is cut from its attachments to the abdominal wall and arteries and veins are stapled shut, surgeons place the kidney in a plastic bag inserted through an incision in the vaginal wall and pull it out through the vaginal opening with a string attached to the bag.Montgomery says the surgery took about three and a half hours, roughly the same as a traditional laparoscopic procedure.The Jan. 29 operation is one of a family of new surgical procedures called natural orifice translumenal endoscopic surgeries (NOTES) that use a natural body opening to remove organs and tissue, according to Anthony Kalloo, M.D., the director of the Division of Gastroenterology at Johns Hopkins University School of Medicine and the pioneer of NOTES. The most common openings used are the mouth, anus and vagina.Since 2004, successful NOTES in humans have removed diseased gallbladders and appendixes through the mouth, and gallbladders, kidneys and appendixes through the vagina.Recently, Kalloo says, some medical experts have called for more studies to compare the safety and effectiveness of NOTES against traditional laparoscopies, which also leave very small scars, have been in use for many years, and are proven to be safer and less painful for patients than older “open” abdominal procedures. He supports more studies.But, he adds, “natural orifice translumenal endoscopic surgery is the final frontier to explore in making surgery scarless, less painful and for obese patients, much safer.” An organ donor, in particular, is most deserving of a scar-free, minimally invasive and pain-free procedure.”Additional surgeons from Johns Hopkins University School of Medicine who participated in the procedure were Andy Singer, M.D., Ph.D., assistant professor in the Division of Transplant Surgery; and Wen Shen, M.D., M.P.H., assistant professor in the Department of Gynecology and Obstetrics.

What a punk.

This guy from Michigan elbowed poor little P.J. Hill. You can see him about ready to land it. Michigan players are scum. He was thrown out of the game. Bucks sent them packing with a 54-72 victory. I was yelling at the end for the bucks to throw up another shot so we could win by 20.

2/3 of the way done

I put together the baby furniture on Monday. One of the cribs was broken. I have to wait to get a replacement part and it will all be done. Only took 4 min to put the crib together. The changing table took longer. So far this baby thing is a snap, for me that is. Michele on the other hand throws up a minimum 2 times a day. Growing babies is tough stuff.

1 Year Down

40 more to go. Thanks again Ryan.

-Neal

Time Flies

It seems like more than a year ago that the transplant happened. One year ago Neal and I and Ryan and Leslie had so many emotions running through us. Neal and I could barely sleep due to anticipation, fear and thoughts of a new life, a second chance you would say. The days leading up to the transplant, Neal was cleaning things around our house that had never been cleaned! I guess we were just trying to find a way to pass the time more quickly. I was more anxious for Ryan and Leslie, because this was all new to them. Neal and I were veterans of being in the hospital and having surgeries, nor did we really have a choice on this surgery. We did not want to continue the dialysis route, it was too brutal. Ryan and Leslie were voluntarily getting into this. I am sure Ryan and Leslie had their own list of emotions! Neal always told me (and I never believed it) that being nice to people would pay back someday. I have to admit he was right in a bigger way than I could have imagined. Thursday we are headed out to a nice dinner with Ryan and Leslie to celebrate the one year anniversary of the transplantation of 'Lil Ryan. This will be a tradition we will carry on for many years.

We have had a great holiday season. We headed to Cleveland to see my extended family for Thanksgiving. The day after Thanksgiving, we were able to have all of our immediate family down to our place for Thanksgiving. We made it up to see Neal's family in December. While in town, Neal was able to catch a very cold Browns game with his family at the stadium. We are very thankful for the wonderful year we have had. For Christmas we got the flu or something else just as horrible! Neal had to spend a couple of nights over at OSU, but was freed on Christmas Day. As Ryan reminded us, that was nothing compared to some prior Christmas'.

Other than the flu or food poisoning Neal picked up for Christmas, his health is better than ever. Neal met with the oncologist in December and had another ultrasound and Lil Ryan is looking great. Ryan is fully recovered also. He had an appointment for a routine physical and everything looks great.

You cannot repay someone for giving you your life back. Try to tell Ryan and Leslie that! One of the first things Neal told Leslie immediately after the transplant was "Tell Ryan thanks, now Michele and I can start our own family". Well that time has come. We are so excited of the news that we are expecting twins. The babies will be here in July. We got to see them again on the 2nd and they were kicking and moving all over the place. We could not have done this without our completely selfless friends. Thanks McHenry's for giving us our life back! 2008 has been an amazing year and 2009 should be just as exciting!

Stacy made us a special pie to celebrate the babies. It was delicious! Perhaps we should have moved the large knife from the picture. I could not help but post a picture.

Burn After Reading

More like Burn Before Watching. Nothing like a comedy with no jokes. I know it was packed with superstars but it can still suck. Believe me it really sucked. One of the worst movies I have ever seen. Don't rent it.