UC Davis transplant surgeon uses minimally invasive technique for kidney donors
One small incision now being used for life-saving, living kidney donations
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Angela Whalen didn't seek out a single-incision nephrectomy surgeon. She simply wanted to save her father's life. The fact that Whalen was able to undergo a unique surgical procedure to donate her kidney, with a barely visible scar to show for it, was the added bonus of a daughter's gift of life to her dad.
Until she traveled to UC Davis Medical Center after finding out she was a donor match, Whalen hadn't even heard of the minimally invasive surgical procedure that Christoph Troppmann, UC Davis professor of surgery, routinely offers kidney donors. Troppmann can remove a kidney through a single port -- or incision site -- at the patient's navel. He is among only a handful of surgeons across the nation who perform the unique procedure.
"Dr. Troppmann told me about the procedure during one of our preliminary meetings, but it really didn't register for me," said Whalen, an Atlanta-area resident. "When it did register was after surgery, when I joked with the doctor, 'Have I actually been in surgery?'"
Over the past year, Troppmann performed approximately 65 living kidney donations using the specialized technique. He says it potentially has multiple benefits compared to the conventional type of laparoscopic transplant surgery, which was a minimally invasive technique pioneered by his colleague Richard Perez at UC Davis Medical Center in 1997.
"The main benefit of a single-incision surgery is that you have just one small opening compared to multiple incisions," said Troppmann, whose patients usually remain in the hospital for only two days. "These donor patients typically have much, much shorter recovery times. That's where we've really seen the difference. It's still amazing to us that a week after surgery, when we see our donors in clinic and ask them to get up from the exam table, it's almost as if they haven't had surgery."
Troppmann noted that living kidney donors must be in good health, and that donating an organ is an elective procedure. His goal is to provide the safest possible procedure, with the least disruption to a patient's family life and job. For donors like Whalen, however, the type of surgical technique is secondary to simply being able to improve the health and well-being of a friend or loved one.
"I didn't think much about the procedure until close to surgery, and then afterwards when I saw the tiny, tiny scar for the first time," said Whalen. "The main thing was just making sure that I could donate my kidney. My feeling was, 'He needs a kidney. He's my father. It's no big deal.'"
At the time of the transplant, Whalen's father, Isaiah Ollison, was on dialysis and on the organ transplant list because of kidney disease. He and his wife had resisted the idea that a family member might donate a kidney. But when Ollison traveled to Georgia for his grandson's high school graduation in 2010, Whalen immediately noticed how weak and tired he looked. It was at that point that she insisted on finding out if she was a match as an organ donor.
"When UC Davis called and said we were a match, I knew we were going to do it," said Whalen. "In fact, up until we were driving to the medical center on transplant day, he was still saying, 'Are you sure you want to do this?' And I said, 'Dad, we're doing this.'"
Whalen's single-port (or "single-site") nephrectomy is the latest development in minimally invasive procedures to safely extract a kidney from living donors. In the conventional laparoscopic nephrectomy, the surgeon makes a small incision in the lower abdomen and inserts a laparoscope -- a tiny tube containing a light and video camera. The surgeon can then navigate and inspect the kidney region with the scope, viewing the scene in high definition on a video monitor above the operating table. The conventional approach also requires three to four additional incisions in the patient's abdomen and as entry points for the surgical instruments.
For the single-port procedure, Troppmann uses a special, dome-shaped platform that is placed on the patient's abdomen. The rubberized device, which he says is a major technological advance, provides him with more surgical leverage and maneuvering capabilities.
"We have the ability to insert our camera and two surgical instruments through one incision site, plus we have the option of inserting a fourth device for retraction purposes," said Troppmann, who works over a period of several hours to carefully separate the donor kidney from surrounding tissues and vessels before maneuvering it into a tiny pouch and extracting it through the same two-inch incision site used for insertion of the single-port instruments at the belly button.
"Once we have the major hollow structures of the ureter, renal artery and renal vein isolated from the kidney and out of the way, we can retrieve the organ and hand it to the recipient surgeon for transplant."
Troppmann's colleague in the daughter-to-father transplantation was John McVicar, professor of surgery, who carefully checked and prepared the donated organ before taking it to an adjacent operating room and transplanting it into Whalen's father.
After spending two days in the hospital, Whalen returned to her parents' home to recuperate. She even tried jogging, admittedly very slowly, not long after the surgery.
"It had been 10 days, and I wanted to get moving," said Whalen. "As much as I could, I went for a jog. It felt good. Of course, there was some tenderness, but I did it."
Troppmann acknowledges that his surgical approach takes slightly longer in the operating room and is more challenging than standard laparoscopic techniques. But he thinks the added benefits for his patients are worth the effort.
"What makes UC Davis unique is that we are likely the only medical center on the West Coast, and perhaps in the western United States, that consistently offers this technique to nearly every donor," said Troppmann. "It's particularly important for me, as a surgeon, to provide my patients with a treatment that has the least adverse physical impact. We want to make donating an organ as easy as possible."
For Angela Whalen and her father Isaiah Ollison, the experiences were positive and the outcomes were even better. Ollison no longer requires thrice-weekly dialysis, and his energy levels have improved significantly.
"I saw my dad that first night right after surgery and he looked wonderful," said Whalen. "He looked like his spirit was back. We're all just amazed and very grateful that he's fine and looks great, and there is no sign of rejection, and that he's going to be okay. The transplant is a blessing."