Laparoscopic donor nephrectomy refers to the procedures used by transplant surgeons to remove a kidney from a healthy donor so that it could be transplanted into another person who is suffering from kidney disease and is on dialysis.
What is laparoscopic surgery ?
Laparoscopic surgery is also known as minimally invasive surgery and describes a surgical procedure which is performed with the assistance of a video camera and several very thin instruments. Incisions are typically up to half an inch or smaller. Through these incisions, plastic tubes called ports are introduced into the abdominal cavity. The video camera and instruments are then inserted into the abdomen so that the surgeon can see inside and perform the operation.
A different approach is the hand-assist technique for some advanced procedures. This involves making one slightly larger incision to insert a hand of the operating surgeon into the abdomen to better assist in the operation, along with other laparoscopic instruments and the video camera.
What are the benefits of the laparoscopic procedure over the conventional open procedure?
The benefits include less post-operative pain and discomfort, quicker recovery, shorter hospital stays, earlier return to full activities, more cosmetically appealing since the scars are much smaller and there is less internal scarring as well.
For the donor nephrectomy, usually 4 to 5 small incisions are made for the dissection and one larger incision to remove the kidney.
What is the work-up involved prior to the surgery?
The work-up includes a history and physical by the nephrologist (kidney specialist) and the surgeon, blood work and urine tests to ensure that there are no underlying medical issues. The BMI should be 36 or below to decrease post-op complication rates. A CT scan is also done to evaluate the anatomy of the kidneys so that the operative procedure could be planned in advance. Usually, the left kidney is removed as it has a longer renal vein and is therefore easier to remove laparoscopically. The right kidney is removed if the surgeon feels it would be safer to remove it because of some pre-existing anatomical variance.
What is the post-operative course after this procedure?
Most donors are able to eat and drink within the first 24 hours after the procedure. Pain medications are given intravenously at first and then orally for pain control. The usual stay in the hospital is 2-3 days. Once regular diet is tolerated and the donor is able to walk without much pain or discomfort, he is discharged home. Follow up at the transplant center is usually a couple of visits in the first month after the procedure accompanied by blood work to ensure everything is normal. Most donors are able to return to full activities within the first 4 to 6 weeks after the procedure and are able to return to work within that time period as well. It is strongly recommended that the donor follow up with his family doctor regularly thereafter to ensure no long term problems after the procedure.