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Login to My HealthGroundbreaking Surgeries Save Kidneys of Two Patients
Two groundbreaking surgeries recently performed by a team of surgeons led by Keck School of Medicine of USC Professor Inderbir Gill, M.D. have allowed two patients who might otherwise have lost their kidneys to keep the organs, with the likelihood of resuming their normal lives.
Gill, founding director of the USC Institute of Urology, is the first in the world to use robotic surgery to repair a rare renal artery aneurysm in a patient who had only one kidney. The patient, Cecile Johnson of Bartlesville, Okla., faced the possibility of renal failure if she didn’t undergo the surgery.
“If I had to make the same decision to do this today, I’d do it again,” said Johnson, 51, who has lived with one kidney since age 17. “I had total trust in Dr. Gill to do this procedure. If there is anyone in the world who could do this surgery, it would be him and his team.”
In another surgery the same week, Gill removed a two-centimeter tumor from inside another patient’s right kidney using a new technology called augmented reality. This new technology allows the surgeon to see where the tumor is located, enabling the surgeon to avoid the kidney’s blood supply and other obstacles.
This patient had a 70 percent chance of losing his kidney,” said Gill. “Using the augmented reality technique made this particular surgery possible. We were able to remove the tumor and save 95 percent of the kidney, without ever stopping the kidney’s blood supply, using a new ‘zero-ischemia’ technique.”
In the case of the renal artery aneurysm, Johnson was referred to Gill by another physician after experiencing pain in her side and high blood pressure. An angiogram revealed a 2.4 centimeter aneurysm on her remaining kidney, most likely caused by fibromuscular dysplasia, a condition in which abnormal cells grow inside an artery, causing narrowing and compromised blood flow to organs.
Originally, Gill had planned to remove the kidney, repair the diseased artery, and put the kidney back in the patient – essentially, an auto-transplant procedure. But after thinking some more, another idea emerged.
“I asked Mrs. Johnson, ‘What if we can eliminate the aneurysm robotically, without having to remove the kidney?’” he said. “It had never been done before in a patient with a solitary kidney anywhere in the world, but with our vast experience in robotic kidney-sparing surgery, we knew she was the perfect candidate for this new procedure.”
Gill used robotic technology to dissect the blood vessels feeding the kidney, isolating the aneurysm and blocking its blood supply. Having mobilized the aneurysm, Gill removed it and repaired the artery.
“That was what I wanted all along,” said Johnson, who works as a supervisor in human resources at Conoco Phillips. “When you only have one kidney, one of your worst fears is that something will go wrong with it.”
In the augmented reality procedure, Gill and his team operated on Gary Fradkin, 58, a Van Nuys resident who had the unusual experience of being diagnosed with tumors on both kidneys.
“I never felt bad,” said Fradkin, a postproduction engineer who develops theatrical trailers. “During a routine physical, my creatinine level was elevated. During ultrasound, the doctors spotted the tumors. The urologist said the tumor in my right kidney was in the middle of the arterial blood supply. He said it was beyond his expertise, and referred me to Dr. Gill.”
Gill planned a laparoscopic procedure, in which four small cuts are made in the patient’s abdomen through which special surgical instruments are inserted to enable the surgeon to reach the kidney.
Gill and his team have performed more than 1,200 minimally invasive kidney-sparing surgeries, but rarely on tumors embedded so completely entirely inside the kidney. Gill’s team for this surgery included Casey Ng, M.D., Mukul Patil, M.D., Masashiko Nakamoto (a computer engineer), Ph.D., and Osamu Ukimura, M.D., director of Image-Guided Surgery and Focal Therapy at the Keck School. Ultra-fine CT scans, with half-millimeter cuts, were used to develop a comprehensive three-dimensional image of the kidney.
“Normally I look at a CT scan on a monitor to make an impression in my head of where the tumor is,” Gill said. “The novel aspect of this procedure is that we were able to see the tumor cradled in the blood supply of the kidney on the computer screen. A normal CT scan can’t show where the blood vessels are. If we don’t know where they are, we can’t save them.”
Nakamoto and Ukimura worked for more than two weeks to develop the 3-D image. With the image guiding him, Gill located the tumor, and while continuing blood flow to the rest of the healthy kidney, removed the tumor without compromising the kidney’s function. This new surgery, zero-ischemia partial nephrectomy, developed by Gill, has been performed by Gill’s team on more than 50 patients to date.
Gill, Nakamoto and Ukimura are currently working on expanding augmented reality to allow the 3-D image of the kidney to be superimposed on top of the live picture of the kidney during surgery, providing an even better guide.
“As we refine this technology, we hope that many urologists will be able to use this novel technology to maximize the chances of saving the patient’s kidney in cases where patients have complex tumors,” Gill said.
Tests revealed that Fradkin’s cancer was completely removed, and he is recovering with good kidney function. An avid windsurfer and snowboarder, he said he was looking forward to getting back to normal activities, including training his German shepherd to compete in agility trials.
