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Hospital Clínic conducts the first kidney extraction through the vagina in Europe

New intervention following guidelines of surgical techniques using the body's natural orifices

IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer

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IMAGE: From left to right: Dr. Concepción Monsalve, anaesthesiologist, Dr. Maria José Ribal, specialist in Urology, Rufina Gilo, the treated patient, Dr. Antonio Alcaraz, head of the Urology Unit, Dr. Alejandro... view more

Credit: Hospital Clínic of Barcelona - IDIBAPS

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 considerably reduced.

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.

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