Kim Johnson, who donated a kidney to her niece four days earlier, poses for a portrait at a relatives home, Monday, Feb. 2, 2009, in Baltimore. Surgeons at Johns Hopkins University removed Johnson's kidney through her vagina, eliminating the need for an abdominal incision that normally leaves a 5- to 6-inch scar.
Surgeons removed a woman's kidney through her vagina so she could give it to her ailing niece, an unusual operation they hope will encourage others to donate because it reduces pain, scarring and recovery time.
"It was easier than childbirth," said Johnson, who has three children.
Transvaginal kidney removals have been done before to remove cancerous or nonfunctioning kidneys, and other diseased organs have also been removed through mouths and other orifices. Many donated kidneys are removed laparoscopically, through small keyhole incisions.
But hospital officials think this may be the first time a donor kidney was removed through the vagina.
The operation left three pea-size scars on the Lexington Park woman's abdomen, one hidden in her navel. Surgeons hope the procedure will lead more women to become donors, said Dr. Robert Montgomery, chief of the transplant division at Johns Hopkins, who led the team that performed the surgery.
Johnson said the operation was less painful than gall bladder surgery and she is recovering more quickly than Gilbert's father, who gave his daughter a kidney 12 years ago.
Gilbert needed the first transplant because repeated infections had destroyed the kidneys she was born with. She needed the second after she began suffering chronic rejection.
Johnson, an assistant sales manager for a St. Mary's County newspaper, said she was able to get out of bed Thursday night, the same day the kidney was removed.
Quicker recovery and less pain are the key benefits of the new technique, said Montgomery and Dr. Anthony Kalloo, the director of the Division of Gastroenterology at Johns Hopkins and a pioneer of the method of using natural orifices for organ removal.
Kalloo said more than 300 such surgeries have been performed worldwide, mostly gall bladder and appendix removal through the mouth, anus and vagina. Kalloo said there has been some resistance in the medical community because of concerns, for example, that stomach acid could leak into the abdominal cavity in operations where organs were removed through the mouth.
Dr. Jihad Kaouk, a urologist and director of the Cleveland Clinic's Center for Laparoscopic and Robotic Surgery, is among those concerned about contamination. He was not involved in Johnson's surgery.
"There is the risk of infection having the kidney passing through a contaminated area and then going to another patient who is immunocompromised," Kaouk said. "That is the concern we have and we would like to monitor the outcome in that regard."
In Johnson's case, Montgomery said a plastic bag placed into her abdominal cavity through a tiny incision protected the donated kidney from contamination by bacteria and other organisms in her vagina. Johnson was chosen because she has had a hysterectomy, which made the operation easier, but the procedure could be used without affecting women's ability to give birth, he said.
More than 78,000 people are on the national waiting list to receive kidneys from deceased donors. The need is increasing as diabetes and obesity rise, threatening to further lengthen a wait that can last years. In 2007, more than a third of the 16,629 kidneys transplanted in the U.S. came from living donors, according to the United Network for Organ Sharing.
Montgomery said the number of living donor transplants has tripled since laparoscopic removal debuted in 1995, providing an alternative to so-called "shark bite" abdominal incisions. He hopes advances such as the vaginal removal will continue the increase.
"We think she'll be probably back to her normal activities within a week or two," the transplant surgeon said. Recovery from laproscopic surgery typically takes several weeks. "So, that greatly reduces the inconvenience of donating and we're hoping that will encourage more people to donate."