Donating through Laparoscopic Surgery
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, to allow the instruments to move the tissue surrounding the kidney. 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 kidney being used for the donation may eliminate the possibility of removing the kidney safely so that it can be transplanted. Fortunately, these circumstances are rare.
Laparoscopic Donor Nephrectomy Candidates
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?
Few transplant centers offer the total laparoscopic technique. At the majority of the programs the hand-assisted laparoscopic technique is used. This has a shorter recovery than the open procedure but longer than the total laparoscopic technique used at HCMC.
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 612-873-7705 or toll free at 1-888-345-0816.