By Tara Hulen
Loma Covin didn’t hesitate to offer to donate one of her kidneys when her husband of 39 years, Larry Covin, needed a transplant and tests showed she’d be a good match. It’s not unusual for a spouse to match as a potential donor, and certainly not unusual for one to eagerly offer. But, in doing so Loma made surgical history. She became the first patient ever to undergo laparoscopic donor surgery of the right kidney performed with a new clamp devised by UAB urologist Rizk El-Galley, M.D. The innovative clamp allowed Loma—and now will allow others—to avoid the more invasive open surgery that previously had been the standard procedure in right kidney donations. The open procedure requires a larger incision and longer recovery time.
Hand-assisted laparoscopic surgery has been the method of choice to harvest left kidneys but, in the past, the method had not been as successful in harvesting right kidneys because of difficulties with the right kidney (renal) vein structure. Therefore, to address those difficulties, open surgery had been the norm. Surgeons had to use a special clamp in right-side open surgery to work with the problematic vein, but the same clamp wouldn’t work in laparoscopic surgery. So, Dr. El-Galley decided to create one.
Dr. El-Galley praises Loma’s bravery to agree to be the first human test subject, but she shrugs that off and is thankful she had the option of this new procedure that made her recovery easier, and restored her husband’s health.
Larry Covin, 59, of Castleberry, Ala., had known since he was 38 that he had polycystic kidney disease, an inherited congenital disease that forms cysts in the kidneys, and can eventually cause high blood pressure and reduced kidney function. Before he got the transplant, the typically active and hard-working Covin was having a hard time doing anything.
“I finally got to where I couldn’t function, and I kept getting weaker and weaker,” Larry says. “I never had any patience for sitting around on the couch.”
When other doctors told him he should get on dialysis, he sought other opinions and was referred to UAB, where a transplant was recommended as the best long-term option. The surgery was performed in May 2004. He started feeling better almost immediately.
Larry’s middle name is Zoma, so Loma and “Zoma” have always been teased about having unusual similar names. The couple says proudly they also “now have matching kidneys.”
Dr. El-Galley and the Covins sat down with ehealth to recount how they became medical pioneers, and why it’s better to have the laparoscopic option.
Dr. El-Galley: “Laparoscopic surgery is better for two reasons, because the incision is smaller—it’s 8 centimeters versus 30 or 40 centimeters—and we go between the muscles. There is less pain involved and the incision heals quicker. We found that 80 percent of laparoscopic donors are back to most of their normal activities in two weeks. In donor patients who have the traditional open surgery,
it takes about six weeks.”
Transplant recipients can accept either kidney equally well, so which kidney is taken from the donor depends on many factors.
Dr. El-Galley: “One important factor is the kidney we leave with the donor has to be perfect; it has to be normal. If there’s anything slightly abnormal about one kidney, then we take it and leave the good kidney for the donor.”
In Mrs. Covin’s case, it was determined that her right kidney was the best option for donation. That normally would have meant invasive open surgery because of those difficulties presented by all right renal veins.
Dr. El-Galley: “The right renal vein is short and not long enough for the transplant surgeon to suture without tension. If there’s tension, it will leak and cause problems.”
In laparoscopic surgery, blood leakage is a problem because it impairs how well a surgeon can see when looking through the camera in the laparoscope. Another issue is the wall of the right renal vein is very thin. To give it extra length and strength, it’s grafted to a piece cut from another vein. That’s where that old special surgical clamp was used in traditional open right-kidney donor surgery, but it wouldn’t work laparoscopically. Right-donor laparoscopic surgery can be done using a staple, but Dr. El-Galley says that method has a decreased transplant success rate.
Frustrated that a new type of clamp was the only thing needed to help right-kidney donors avoid the more painful open surgery, Dr. El-Galley was determined to make one. He collaborated with the hospital’s engineers, machine shop and an outside engineer who was a friend of a patient who was a NASA engineer. It took six months to get the right design.
Dr. El-Galley: “We went through about seven versions of modifications to improve the angles, because when you work in laparoscopy, you don’t have the freedom to move this way or that way.”
When Larry Covin was referred to UAB for a transplant and Loma was approved as a donor match, Dr. El-Galley approached her about trying the new surgical technique, and she agreed.
Dr. El-Galley: “We had a plan B. If the new laparoscopic clamp didn’t work properly, then we would proceed to open surgery. She bravely said, ‘Go ahead and do it, just do it, I trust you.’ Ultimately, we went in and it all worked well.”
Loma: “I had such peace…I knew whatever we decided to do, it was going to work. I just knew God had answered our prayers and everything was going to be great, and it has been. We did this on a Tuesday, and I was able to go home on Thursday. I was able to come up here and stay with Larry, which I probably couldn’t have done if I had undergone open surgery. When I went home, I was able to take care of myself without any help. It is medical technology, but still, it’s a miracle.”
More people might be willing to donate kidneys now that the less painful laparoscopic surgery can be done on either side, but people donating a kidney for a loved one don’t usually hesitate either way, Dr. El-Galley says. Regardless, they all deserve to have the easiest surgery possible, he adds. The humble, humorous and honest Loma jokes that the choice was easy for her because it would make her life better in two ways—she’d have a faster, less painful recovery and Larry wouldn’t be lying around on the couch all day.
Loma: “I had too many years invested in him to give up now. I wanted my husband back. Larry’s a different man than he was before the transplant. Dr. El-Galley has been so good to me, and so humble and appreciative for me doing this, and I felt like the whole time ‘I’m doing this for me, not for you.’ My recovery was a piece of cake compared to what I imagined it would have been. And after this, I felt like I got my husband back.”
In the first year since Loma’s surgery, Dr. El-Galley has done more than 50 right-kidney hand-assisted laparoscopic donor nephrectomies. He stresses the technique requires proper training. But after now routinely performing this operation, Dr. El-Galley says that for him, the right kidney is no longer the most difficult or least desirable option.
Dr. El-Galley: “In fact, the right side is quicker to do. On the right side, there’s no spleen above the kidney, and there are not many things you have to undo to get the right kidney. Doing it this way gives us more freedom to choose which kidney. Before, we tended to accept the left kidney if we could. Now we don’t worry about which one.”
For information about kidney transplantation at UAB, call UAB HealthFinder at (205) 934-9999 or 1-800-UAB-8816 or visit www.health.uab.edu/kidneytransplant.