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Leading Edge

Single Incision Kidney Surgery Can Result in Less Pain and Shorter Recovery Time than Traditional Surgery

John Houle

It was a painful fall, but it ended up saving John Houle's life.

The 52-year old was walking out to the hot tub at his Weare, New Hampshire home last March when he slipped and fell, slamming his lower back on the edge of the porch steps. A firefighter and member of the Pat's Peak Ski Patrol, the strong and athletic Houle brushed himself off, soaked in the hot tub for a bit, and went to work.

Two days later he noticed blood in his urine and immediately went to his local hospital for tests.

Kidney cancer

"The nurse practitioner basically told me I had hypernephroma and I should look it up on the Internet to find out exactly what it is," recalls Houle.

A shaken Houle discovered that hypernephroma is actually another term for a kidney cancer. He contacted a local urologist, who performed more tests, then told Houle that blood in his urine was not a symptom of hypernephroma. Confused and concerned, Houle decided it was time for a second opinion.

"My wife and I left the doctor's office and said, 'We're going to Boston,'" he remembers.

A relative referred the couple to Dr. Andrew Wagner, Director of  Minimally Invasive Urologic Surgery at Beth Israel Deaconess Medical Center. More testing revealed that Houle did in fact have a medium sized tumor in the center of his kidney. The good news was, they caught the cancer early and it could be removed using a minimally invasive technique called single incision laparoscopic kidney surgery.

Single incision kidney surgery requires only one incision near the belly button.

"As strange as it sounds, that office visit was a really good experience," says Houle. "Dr. Wagner was great. He explained everything about the procedure and answered all my questions. I felt really confident with him."

Houle had every reason to feel confident. Dr. Wagner has performed nearly 500 kidney surgeries in his career and is one of the few doctors in New England doing the more complicated single incision kidney surgery. He says it is more difficult for the doctor, but much less painful for the patient.

"Traditional "open" kidney surgery requires a large flank incision - up to 18 inches long. Patients end up spending several days in the hospital and have as much as 12 weeks of recovery," notes Dr. Wagner.

GelPOINT Advanced Access Platform

Regular laparoscopic surgery is less invasive, but still requires 4-5 small incisions to remove the kidney, while single incision kidney surgery requires only one incision near the belly button.

"The laparoscopic camera and surgical instruments enter through that one small incision, so maneuvering the instruments is more challenging than regular laparoscopic kidney surgery. It's a very difficult procedure for the surgeon and not many are trained to do it yet," says Dr. Wagner. "In properly trained hands it's not any more dangerous than regular laparoscopic surgery, it just takes a bit longer."

Single incision kidney surgery isn't for everyone. The best candidates have a tumor that is less than 7 cm in diameter, are not overweight, and have not had a lot of abdominal surgery. Currently, the surgery is only being used for complete kidney removal. And because it's a relatively new surgical approach, Dr. Wagner and his team are collecting data to see how well patients are benefiting from the procedure.

"John's case is a great example - he had very little pain early on and was back to his physical baseline within two weeks of the surgery," Dr. Wagner notes.

In fact, Houle was back to fighting fires ten weeks after leaving the hospital. Now he's looking forward to being front and center next year when his son graduates high school and his daughter finishes college.

"It just amazes me that if I hadn't fallen, I would never have known I had a tumor growing inside of me," says Houle. "I'm so fortunate and definitely made the right decision going to BIDMC. It was worth the trip."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2010

Contact Information

Center for Minimally Invasive Urologic Surgery
Beth Israel Deaconess Medical Center
Shapiro Clinical Center
330 Brookline Avenue
Boston, MA 02215