The patient, 64-year-old Thomas Manning, had part of his penis surgically removed four years ago after doctors found he had penile cancer. The news marked a step forward in transplant medicine, but as a resident physician and future primary care doctor, I wondered whether such an elaborate and expensive “proof-of-concept” operation would mean anything for my future patients.
The facts behind the big story:
What did the operation aim to accomplish?
The goals of this operation, according to Dr. Dicken Ko, who co-led the surgical team, were threefold: to reconstruct natural-appearing genitalia, to allow the patient to urinate normally and, hopefully, to help him regain sexual functioning.
They have achieved the first goal, and they are hopeful that Manning will be able to urinate normally in a few weeks. Finally, they did extensive reconstruction of the nerves as well, and are hopeful that he will have normal sexual function in the future.
How was this patient chosen?
For Manning, the motivation to volunteer for this experimental procedure was straightforward. “Because they cut off my penis. Very simple. Very, very simple,” he said in a phone interview. Manning volunteered for the operation and underwent extensive psychological evaluation, according to his team.
The type of injury he had was also an important factor: Because part of his penis had been surgically removed — rather than injured in an explosion — the rest of the vessels and nerves were preserved, which facilitated the operation. This was important, Dr. Ko said, because they wanted to pick a patient who was very likely to have a successful outcome to be the first to receive the transplant.
How difficult was this operation?
The main technical difficulties of the operation had to do with the vascular reconstruction involved, which is when doctors sew together the small blood vessels of the patient to the donor’s vessels.
Before the operation, they had only a vague idea if the vessels were big enough to connect. They also performed a vein graft, which is akin to a heart bypass and allows greater blood flow. That vein graft was the primary difference between the technical aspects of this operation and the first successful transplant, performed earlier this year in South Africa.
Who else could benefit from this surgery?
For now, the surgeons on this team are focusing on cancer and trauma patients, especially veterans returning with combat wounds from Iraq and Afghanistan.
The technical challenges for soldiers injured by explosions are likely to be more daunting, as the injuries are generally more extensive and their own vessels and nerves are less well-preserved. Nonetheless, the surgeons emphasized how motivated they were to work with veterans.
In a statement, Manning himself said he hoped the operation could soon be performed on “service members who put their lives on the line and suffer serious damage as a result.”
When asked about the potential for use with transgender patients, Dr. Curtis Cetrulo, a plastic surgeon and the second team leader, said it could be possible in the future. The approach, however, would have to be completely different and would require “a whole new effort” to be successful, he said. Continue reading