Scientific News Health care Surgery Hospital Clínic conducts the first kidney extraction through the vagina in Europe|
conducts the first kidney extraction through the vagina in Europe
New intervention following guidelines of surgical
techniques using the body's natural orifices
This is the first time this intervention has been
conducted in Europe, and the second in the world. Thanks to the work of the
expert group of Hospital Clínic de Barcelona, the extirpation of a kidney
‒affected by a malignant tumour‒ through the vagina has been
achieved. This fact sets a milestone in the framework of minimally invasive
surgery. The operation, presented this morning in a press conference, uses
several cutting edge technology instruments of advanced surgery.
The medical group of Hospital Clínic which has
made possible the first European extraction of a kidney through the vagina has
been led by Dr. Antonio Alcaraz, head of the Urology Unit; Dr. Mª José Ribal,
specialist in Urology and Dr. Alejandro Molina, resident physician of Urology.
This intervention had also the collaboration of Dra. Concepcion Monsalve,
anaesthesiologist, Mrs. Ana Palacio, instrumentist, and Dr. Francesc Carmona,
Head of Gynaecology of the same centre.
Transvaginal nephrectomy is a technique
permitting kidney extraction with only two small incisions in the abdomen of
approximately 1 cm each. Furthermore, another non visible incision is done in
the internal part of the vagina, where the kidney is extracted. This innovation
makes possible that the operated patient has a short and less painful
post-operatory and minimises the aesthetic impact of the operation, since it
does not cause visible abdominal scars.
Until now, urology specialists of Hospital Clínic
have put their hopes in nephrectomy assisted by laparoscopy as the technique
used for the surgical treatment of these pathologies; a revolutionary and strong
technique which has achieved notable results during the last six years and that
has permitted to improve patient care regarding post-operation pain and hospital
stay. Nevertheless, apart from the explained advantages, laparoscopy still
requires, as occurs in traditional surgery, an abdominal incision for the kidney,
leaving a scar of approximately 6 centimetres.
Contrarily to laparoscopy, transvaginal
nephrectomy uses the vaginal orifice and the delivery channel to extract the
tumour, a mass which in this case measured 13 cm height, 8 cm width and 5 cm
depth. From flexible optics of great precision, supplied by Olympus ‒is
introduced in the vagina‒, and two small ways of entry to the abdomen
‒where the instrumental to separate the kidney is inserted‒, the
extirpation of the organ is achieved without large incisions.
Thus, this technique has achieved to avoid
external scars and improved patient care, with a decrease of post-operatory pain
and a hospital stay of less than 48 hours. This success has been possible thanks
to an intensive programme of experimental research conducted by the Urology Unit
of the Hospital Clínic and which has culminated with the conduction of this
procedure. This minimally invasive technique has its basis in the NOTES
programme (Natural Orifice Transluminal Endoscopy Surgery) a point of view which
aims to conduct surgery through the natural orifices of the body, widely
supported by the Hospital Clínic.
More precisely, the centre has two clear
precedents of interventions following the guidelines of the NOTES programme.
Recently, the Service of Gastrointestinal Surgery of Hospital Clínic conducted
successfully two pioneer interventions in Spain, where surgery was developed
through the natural pathways of the body. One of them was the extraction of the
bile vesicle through the mouth, and the other was an intervention for the
treatment of gastroesophageal reflux. None of these cases required incisions and,
as occurs in transvaginal nephrectomy, both hospital stay and complications were
With this achievement, Hospital Clínic de
Barcelona is consolidated as a reference centre in the development of new
strategies to make progress in image-guided surgery. The NOTES programme is a
real revolution, with an only aim: to benefit the patient with a reduction of
pain and of time of recovery and the absence of external scars.
Contact: Marc de Semir
Publishing date: April 21, 2008
IDIBAPS - Institut d'Investigacions Biomèdiques
August Pi i Sunyer