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Published: Friday, 7/18/2008

Bellybutton provides physicians, patients an easier surgical route

ASSOCIATED PRESS
Scott Bolender received a kidney from his niece in a surgical procedure yesterday at Cleveland Clinic. Dr. Inderbir S. Gill explains the procdure by which he removed a kidney through the navel of Chandra Calentine, right, for her uncle. Scott Bolender received a kidney from his niece in a surgical procedure yesterday at Cleveland Clinic. Dr. Inderbir S. Gill explains the procdure by which he removed a kidney through the navel of Chandra Calentine, right, for her uncle.
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CLEVELAND - 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," Mr. Kaster, 29, said. "I can't even see it."

He was the 10th donor to undergo the procedure at the Cleveland Clinic.

Dr. Inderbir S. Gill and colleagues at the research hospital yesterday performed the 11th such procedure, which Dr. Gill said 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 United States 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 said the return-to-work time for single-point donors is about 17 days, versus 51 days for traditional multiincision laparoscopic procedure.

"For me, that's huge so I can get back to work," Mr. Kaster, a self-employed optometrist, said.

Patients of the new procedure were on pain pills fewer than four days on average, compared with 26 days for laparoscopic patients.

"This represents an advance, for the field of surgery in general," said Dr. Gill, who predicted the bellybutton entry would be used more often for major abdominal surgery in a "nearly scar-free" way.

"Will this decrease the disincentive to [kidney] donation? I think the answer is yes," Dr. Gill 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 exploring ways to eliminate scars by putting instruments through the body's natural openings, such as the mouth, nose, and vagina to perform surgery.

Scott Bolender, 39, of Washington Court House, Ohio, received a kidney yesterday from his niece, Chanda Calentine, by way of her bellybutton.

"I'm just looking forward to getting out of bed," Mr. Bolender said before the procedure.

Mr. 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.

Ms. 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 tubelike port with several round entry points for 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 fistlike size. The incision is expanded to about 1 1/2 inches to extract the kidney after the port is removed.



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