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At Hennepin County Medical Center (HCMC), our commitment
to providing the highest quality care to our patients includes using the
most advanced medical technology available. The most recent development
is laparoscopic removal of the living donor kidney (laparoscopic nephrectomy),
which greatly reduces the recovery time and discomfort for the donor.
What is
laparoscopic surgery?
Laparoscopic surgery is a less invasive technique being used for
many abdominal operations. Prior to laparoscopic surgery, all abdominal
surgery involved making a large incision and performing the operation
(under direct vision) through the opening that was created.
In laparoscopic surgery, a few small openings
into the abdominal space are made. Through one of these openings a small
telescope, with an attached camera, is placed. This allows the surgeon
to view the abdominal contents. Through the remaining opening, instruments
are placed, and the operation is performed while viewing a video monitor.
How is laparoscopic
nephrectomy performed?
With the donor lying on their side, four or five small incisions are made,
allowing access to the abdominal cavity. The laparoscope with the camera
attached is placed through one of the incisions located below the navel.
The other incisions are placed at strategic locations on the abdomen and
the operating instruments are placed through these openings. The kidney
is located, and surrounding tissue is moved away. The blood vessels to
the kidney and the ureter are identified and freed from surrounding tissue.
The blood vessels are securely closed and divided using a special stapling
device. After the kidney has been totally freed, it is placed into a plastic
pouch to protect it. The incision below the navel is extended to two inches,
and the kidney (in the pouch) is removed through this incision. Once the
kidney is brought to the outside, a special cold solution is flushed through
the blood vessels, and the kidney is cooled. This preserves the kidney
while it is outside the body. The kidney is then transported to an adjoining
operating room where the recipient is ready to receive it.
What is
the advantage of having laparoscopic nephrectomy?
In the conventional open surgery, an incision is made on the donor's side.
This involves cutting muscles and occasionally removing a rib in order
to create a space where the surgeon can safely remove the kidney. The
patient's recovery from this surgery is often uncomfortable and requires
a significant recovery period until they are able to return to normal
activity.
Patients undergoing laparoscopic nephrectomy
have experienced much less discomfort following this surgery. This has
enabled them to leave the hospital sooner and return to normal activity
and employment much earlier. As compared to the conventional open surgery,
the donors feel better and recover faster.
Who is able
to have laparoscopic surgery versus conventional surgery?
Most donors are eligible to have the surgery laparoscopically. Previous
surgery or unusual blood vessels to the left kidney may eliminate the
possibility of removing the kidney safely so that it can be transplanted.
Fortunately, these circumstances are rare.
What are
the risks of having a laparoscopic donor nephrectomy?
With any surgery, whether performed in an open or laparoscopic technique,
there are risks of bleeding, infection, blood clot formation, wound problems,
and with the anesthetic. Laparoscopic nephrectomy has been shown to be
safe, and many of these complications are less likely to occur.
How well
do kidneys function that are taken out laparoscopically?
The recipients of laparoscopically removed kidneys do as well as the recipients
who receive a conventionally removed kidney.
Do all transplant
centers perform laparoscopic donor nephrectomies?
No, there are very few transplant centers that have surgeons who are skilled
at performing laparoscopic surgery. Due to the level of surgical skill
necessary, it is extremely important that a surgeon experienced in performing
laparoscopic nephrectomies for donation perform the surgery.
For more information about laparoscopic nephrectomy,
contact the HCMC Transplant Coordinators at (612)
347-5931,
or toll free at 1-888-345-0816.
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