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. Montgomery says the surgery took about three and a half hours, roughly the same as a traditional laparoscopic procedure. 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. Video images displayed on monitors guide surgeons’ movements. 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. “Removing the kidney through a natural opening should hasten the patient’s recovery and provide a better cosmetic result.”īoth laparoscopies and transvaginal operations are enabled by wandlike cameras and tools inserted through small incisions. “That incision is thought to significantly add to the patient’s pain, hospitalization and convalescence,” 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. 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. 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. “In contrast to removing diseased kidneys, this procedure has to deliver a perfect kidney since it will be used by the recipient,” says Allaf. Allaf has performed a previous transvaginal nephrectomy on a diseased kidney, but this was the first time he has operated on a kidney donor. Allaf, M.D., assistant professor in the departments of Urology and Biomedical Engineering and director of minimally invasive and robotic surgery. The novel surgery was performed by Mohamad E. 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 transvaginal donor kidney extraction, performed Jan. “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. Interposition of omentum may prevent this problem.February 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.
STAPLED VAGINA FULL
Ultimately, surgical intervention was required, following which the patient made a full recovery. We postulate that pelvic irradiation was partly a causative factor alongside subsequent mechanical irritation. We present an as of yet unreported case of fistulation between the upper horizontal staple line of a colonic J-pouch-the tip of the ‘J’-which was formed extracorporeally with the posterior vaginal fornix. Rectovaginal fistulation is a recognised complication of this form of surgery usually occurring because of technical failure leading to inclusion of the vaginal wall into the stapled anastomosis.
It is thought this can help prevent the onset of LAR syndrome as well as improve the quality of life in the first two years following surgery. Formation of a colonic J-pouch with anastomosis to the rectal stump is an accepted form of reconstruction after low anterior resection (LAR) for rectal carcinoma.
0 kommentar(er)
