My kidney was removed through my belly button

My kidney was removed through my belly button

By Lucy Elkins
Last updated at 8:35 PM on 18th May 2009

Surgery for kidney and gallbladder problems usually involves a major scar across the abdomen or puncture marks from keyhole surgery. Now, a pioneering technique allows surgeons to operate through the belly button, meaning there are no scars.

Susan White, a 30-year-old nurse from Reigate, Surrey, was the first patient in Europe to have this operation.

She tells LUCY ELKINS her story, and her surgeon explains the procedure.

When I was two, I had emergency surgery to remove a blocked part of my urethra - the tube connecting the kidney to the bladder.

The blockage meant my left kidney was working at only 33 per cent of its normal capacity. Overnight, I’d gone from being a healthy toddler to pale and listless.

However, the doctors were fairly confident that as my other kidney was fine, I would need no further treatment. The only reminder was a three-inch scar beside my belly button which occasionally felt lumpy and sore and made me feel a bit self-conscious when I went swimming. But I was otherwise healthy.

Then, in September 2007, I started to develop occasional twinges in the left side of my back. When these didn’t go away, my GP tested me and found blood in my urine, so I was referred to Mr Abhay Rane, a urological specialist, at East Surrey Hospital.

Further tests and a scan revealed my left kidney had deteriorated even further. More worrying, this diseased kidney was producing a hormone that had pushed my blood pressure from normal to high, so I would need medication.

Without treatment, I was at risk of complications such as heart and sight problems.

I was so shocked. I was only 29 and did not want to be on medication for the rest of my life. Fortunately, Mr Rane said removing the kidney would resolve the problem. Even better, he said he could remove the damaged kidney through my belly button, so there would be no scarring.

I’m not a vain person, but as a nurse I knew even a keyhole operation would leave five little scars on my abdomen.

With this new technique, everything - the instruments and camera - would be passed through the middle of my belly button.

I was also coming towards the end of my nurse’s training and was keen to get back to work as quickly as possible. The fewer incisions I had, the quicker I’d heal.

I admit I was nervous at being the first patient in the country to have the procedure, but I’d seen Mr Rane operate during my training and trusted him.

The operation went ahead in March last year. The night before I had to fast and have a horrible drink to empty my bowels (this makes it easier to get at the kidney).

The operation lasted 90 minutes, and when I came round the only visible sign that I’d had an operation was a small gauze dressing over my belly button.

For the first 24 hours I was on a morphine drip, but I was walking the next day and went home three days later. My tummy felt a bit bruised for the first week, but having seen people who’ve had alternative methods of surgery, I know I recovered much, much quicker. I was back at work within two weeks, compared with up to three weeks for keyhole surgery.

To my delight, a check-up a few weeks later revealed my blood pressure had returned to normal.

It still amazes me that I had one of my organs removed, yet no one looking at my body would ever know.

THE SURGEON

Mr Abhay Rane is a consultant urological surgeon at the East Surrey Hospital, Redhill.

He says... The traditional technique for removing a kidney involves making an incision of between 20cm and 40cm long, depending how big the surgeon’s hands are - they have to physically reach inside to remove it.

Fifty years ago, most surgery was done like this and left big scars - as well as running a bigger risk of infection.

Now, most kidney surgery is done using the keyhole technique. This involves making three to five little holes above and around the bikini and tummy line, through which a telescope and the instruments are inserted inside cylindrical tubes called ports.

In through the navel: The surgeon needed just a 2cm cut around the circumference of the belly button
The kidney is then cut into small pieces inside the abdomen and these are pulled out through two of the holes. However, it still leaves a number of scars afterwards, which younger patients in particular can be self-conscious about.

Scars can also lead to long-term discomfort, as any incision made cuts through nerves. These can take a while to heal and also create scar tissue. The rule is that the fewer and smaller the incisions, the quicker your recovery.

Five years ago, some colleagues and I theorised that when performing kidney or gallbladder surgery - which typically involves going in though the abdomen - we could operate through the belly button, which is itself a natural scar.

But to do this, we had to make two significant leaps. First, we had to develop a single tube or port through which all our instruments could be inserted. We came up with one just 2cm wide.

We then had to develop instruments small enough to fit through the port. They needed to be just 5mm wide - half the normal width for operating instruments - and be able to bend at the different angles required to carry out surgery.

I first performed the technique on a patient in India four years ago. At the time I was waiting for the new surgical equipment to be licensed, so I could not use it in Europe. The operation was a great success.

When Susan came to see me, it struck me that she was an ideal person for the technique. She was young, wished to avoid scarring and wanted a quick recovery.

During the operation, I first made a 2cm cut in her belly button through which I inserted the port. (Although most people’s belly buttons are smaller than 2cm in diameter, the incision is curved around the shape of it, so no scar is visible.)

Thereafter, the procedure is very much the same as keyhole surgery, except we’re going through just one incision.

I put carbon dioxide through a tube to inflate Susan’s abdomen slightly - this gives me more room to move the instruments. Then I inserted a telescope to help me see what I was doing, and a scalpel and scissors.

First, had to disconnect Susan’s left kidney from the blood supply and tie that off. I then inserted a small retrievable bag that folds up to about 1cm wide, but once inside the abdomen opens up to about 10cm. I used that to encase the kidney and draw it up to the belly button.
Using my scissors and scalpel, I then mashed up the kidney inside the abdomen so it could be brought out of the belly button in tiny pieces. (Obviously there’s not enough room to bring it all out in one piece.)

The technique takes around an hour - the same as traditional keyhole surgery - but is not suitable for everyone.

You couldn’t use it to extract a large cancerous tumour, for example, as there wouldn’t be enough room to extract it all through the belly button.

Cutting up the tumour would be too risky. If the bag broke, cancer cells could leak back into the body, which would be disastrous.

However, U.S. surgeons are using this technique for hysterectomies - removing the uterus through the belly button.

And my colleagues and I are running a trial to see if people who have belly button surgery can go home quicker than those having other forms of kidney and gallbladder surgery.

From the eight operations we’ve done so far, it does seem they can go home quicker, and they appear to require less pain medication.

If our trial can prove this, it means this technique not only gives a better outcome for the patient, but it will also save the NHS money.

• The operation costs the NHS about £6,000.

http://www.dailymail.co.uk/health/article-1184282/Me-operation-My-kidney-removed-belly-button.html?ITO=1490#