Cleveland Clinic Taking Kidneys Through Navel

July 17, 2008— -- CLEVELAND (AP) - Brad Kaster donated a kidney to his father thisweek, and he barely has a scar to show for it.

The kidney was removed through a single incision in hisbellybutton, a surgical procedure Cleveland Clinic doctors say willreduce recovery time and leave almost no scarring.

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

Kaster was the 10th donor to undergo the procedure at theCleveland Clinic. Dr. Inderbir S. Gill and colleagues at theresearch hospital on Thursday were to perform the 11th suchprocedure, which Gill said could make kidney donations morepalatable by sharply reducing recovery time.

More than 80,000 Americans are awaiting kidney transplants. Lastyear, there were about 13,300 kidney donors in the U.S., and about45 percent were living donors, according to the Organ Procurementand Transplantation Network.

The first 10 recipients and donors whose transplants used thesingle-incision navel procedure have done well, according to theresearchers. They report on the first four patients in the Augustissue of the Journal of Urology.

Preliminary data from the first nine donors who had thebellybutton procedure showed they recovered in about just under amonth, while donors who underwent the standard laparoscopicprocedure with four to six "key hole" incisions took just longerthan three months to recover.

The clinic says the return to work time for single-point donorsis about 17 days, versus 51 for traditional multi-incisionlaparoscopic 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 fourdays on average, compared with 26 days for laparoscopic patients.

"This represents an advance, for the field of surgery ingeneral," said Gill, who predicted the bellybutton entry would beused increasingly for major abdominal surgery in a "nearlyscar-free" way.

"Will this decrease the disincentive to (kidney) donation? Ithink the answer is yes," Gill said.

Drs. Paul Curcillo and Stephanie King of Drexel UniversityCollege of Medicine in Philadelphia developed a single-incisiontechnique and Curcillo was the first to use the method to remove awoman's gallbladder through her bellybutton in May 2007. They'vesince used it for a number of different kinds of surgery.

Curcillo said the bellybutton procedure "will definitely makethings better" for the donor. "A donor is one of the mostaltruistic people you'll ever meet. He's giving his kidney up. Soanything you can do to make it better for that patient, theydeserve it," he said.

Laparoscopic surgery revolutionized the operating room more than15 years ago, replacing long incisions with small cuts and vastlyreducing pain and recovery time. Researchers are now exploring waysto eliminate scars by putting instruments through the body'snatural openings like the mouth, nose and vagina to performsurgery.

The method used by the Cleveland Clinic takes advantage of thebelly button to avoid a visible scar. Gill said the procedure wasapproved by the clinic's internal review board as an extension ofits laparoscopic surgical work. He has begun training othersurgeons on the procedure. It is not used to transplant the kidneyinto the receiving patient.

Dr. Louis R. Kavoussi, head of the Arthur Smith Institute forUrology of the North Shore Long Island Jewish Health System in NewYork and the co-author of an editorial in the journal, said themethod needs to be studied to determine if patients fare better."The reality is that nobody knows if this is an advance other thancosmetic," said Kavoussi.

Scott Bolender, 39, of Washington Court House, was to receive akidney Thursday from his niece, Chanda Calentine, by way of herbellybutton.

"I'm just looking forward to getting out of bed," Bolendersaid in a bedside interview Wednesday.

Bolender, the married father of six children, has been unable towork because of Wagner's disease, an autoimmune disease thatattacks the kidneys. He has been undergoing lifesaving dialysissince 2005.

Calentine, 30, of New York City, said she was thrilled toprovide a kidney for her good-natured uncle and that she expects todo fine with a single remaining kidney.

She also said she was confident in the promise of a "nearlyscar-free" post-surgical bellybutton but was prepared for thealternative. "A week ago I got a one-piece (bathing suit)," shesaid with a laugh.

The procedure involves making a three-quarter inch incision inthe interior of the bellybutton and inserting a tube-like port withseveral round entry points for inserting a camera and other toolsinto the belly.

The belly is inflated with carbon dioxide to provide maneuveringroom. The kidney is then freed from connecting tissue, wrapped in aplastic bag and removed through the navel when the blood supply iscut, shrinking the organ's fist-like size. The incision is expandedto about 1½ inches to extract the kidney after the port is removed.

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

Kaster donated his kidney to his father, Phil Kaster, 61, ofCanal Fulton, who was on dialysis for 10 months.

"When it's family like that, you wouldn't think twice," hesaid. "I'm glad I'm able to give somebody their life back."

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Associated Press writers Joe Milicia in Cleveland and StephanieNano 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

(Copyright 2008 by The Associated Press. All Rights Reserved.)