There is an ever increasing demand for living kidney donors. Until recently, kidney donation from a living donor could only be accomplished through a surgical procedure called open nephrectomy (kidney removal). This procedure requires a large, muscle cutting abdominal incision; removal of a rib; and a relatively longer hospital stay and recovery period.
However, advances in laparoscopic surgery have made an advanced surgical procedure called laparoscopic donor nephrectomy possible. This procedure has significant benefits over the traditional open surgery for kidney donation.
What is laparoscopic donor nephrectomy?
Laparoscopy—also known as “keyhole surgery”—is a minimally invasive surgical procedure in which a special camera, called a laparoscope, is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a real-life picture of the internal organs to a video monitor, to guide them through surgical procedures. The laparoscope magnifies these images many times their actual size, providing surgeons with a superior view of the abdomen.
Laparoscopic nephrectomy is a minimally invasive procedure that uses a laparoscope to remove a kidney for donation. Laparoscopic kidney removal is considered minimally invasive because it only requires three or four small non-muscle-cutting incisions rather than one large muscle-cutting incision in the abdomen. (See the figures below.)
Figure 1: Positions of small incisions for laparoscopic donor nephrectomy surgery. No muscle is cut for any of these incisions.
Figure 2: Muscle-cutting incision (6- to 10-inches long) used in traditional open nephrectomy surgery.
During the procedure, carbon dioxide is passed through one of the incisions into the abdominal cavity to lift the abdominal wall away from the organs below, creating more operating space to perform the surgery. The pencil-thin laparoscope and surgical instruments are then inserted through the other incisions.
At the end of the procedure, the kidney is removed through a 7 cm, non-muscle-cutting incision in the bikini area.
What are the advantages of laparoscopic donor nephrectomy?
Because laparoscopic donor nephrectomy is a minimally invasive procedure, donor patients experience significantly less discomfort, have a shorter recovery period and return to work quicker than donors who had traditional open surgery.
Because the incisions are small, laparoscopic donor nephrectomy causes reduced post-operative pain and shorter hospital stays, and patients experience a quicker return to normal eating habits and daily activities.
See the comparison between laparoscopic and open nephrectomy.
Who is a candidate for laparoscopic donor nephrectomy?
Most people who are eligible for open nephrectomy are also eligible for laparoscopic nephrectomy. However, you may not qualify for the procedure if:
- You have had multiple previous abdominal surgeries.
- You are significantly overweight.
- There is abnormal anatomy of the kidney.
A physician will complete a preoperative evaluation to ensure that laparoscopic nephrectomy is appropriate for you. However, in a small percentage of cases, even approved laparoscopic procedures may be converted to open procedures.
Pre-transplant donor evaluation
The pre-transplant donor evaluation provides complete information about your overall health and helps to identify any potential problems. During your evaluation you will have several tests performed, including a renal arteriogram, which examines the vascular system of the kidneys.
||Laparoscopic Donor Nephrectomy
||Open Donor Nephrectomy
||Three half-inch incisions in the abdomen; one 2.5- to 3-inch incision low in the abdomen, in the bikini area. No muscle is cut during any of these incisions.
||A 6- to 10-inch muscle cutting incision on the side of the abdomen; frequently requires removal of one rib.
|Length of Hospital Stay
||1 to 2 days
||3 to 5 days
||Less scarring after surgery.
Less discomfort and decreased need for pain medication.
|Increased scarring after surgery.
Greater need for pain medication.
|Return to Normal Activity
||2 to 4 weeks
||8 to 12 weeks
There also will be several additional tests to make sure you are physically ready for the surgery.
You will have a complete physical examination and meet with several health care providers, including the surgeon, who will ask you questions about your condition and your health history. You also will meet with an anesthesiologist, a physician who specializes in sedation and pain relief during and after surgery.
Your surgeon or nurse will give you specific instructions to prepare for these tests. You also may ask the health care professionals questions about the procedure at any time during this process.
During the surgery
- The surgeon will insert a small needle into your abdominal cavity. The needle is connected to sterile tubing. Through the tubing, carbon dioxide is passed into the abdominal cavity to lift the abdominal wall away from the organs below. This space provides your surgeon with an excellent view and more operating space.
- A small keyhole incision will be made near the upper left side of your abdomen. The laparoscope, which is connected to a video camera, is placed through this incision. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.
- Before starting the surgery, your surgeon will take a thorough look at your abdominal cavity to make sure that laparoscopy will be safe for you.
- Two to three additional small incisions will give your surgeon access to the abdominal cavity in order to perform the surgery. None of the incisions cut any muscle.
- Once the kidney is separated, your surgeon will remove it through a non-muscle cutting incision in your bikini area. Another surgical team will then immediately prepare the kidney for transplant into the recipient while your surgeon completes your procedure.
- Finally, your surgeon will check that there are no areas of bleeding, empty the carbon dioxide gas from the abdominal cavity and close the small incisions.&
After the surgery
You may be discharged from the hospital as soon as the day after surgery, or 1 to 2 days later.
- You may begin to drink clear liquids the morning after surgery.
- You will gradually be able to eat solid foods (within 2 to 3 days after surgery).
- You will be encouraged to get out of bed, starting the first day after surgery.
- The more you move, the less chance for complications such as pneumonia or blood clots in your legs.
- For 2 to 4 weeks after surgery, do not lift or push anything over 10 pounds.
- Avoid activities that increase abdominal pressure, especially sit-ups.
- You may resume normal activities after 2 to 4 weeks.
- You are encouraged to gradually increase your activity level.
- Walking will help your general recovery by strengthening your muscles, keeping your blood circulating to prevent blood clots and helping your lungs remain clear.
- Your incisions will be covered with small pieces of tape (called steri-strips), that will gradually fall off on their own.
- If the strips do not fall off on their own, your health care provider will remove them at your 2-week follow-up appointment.
- You may notice some minor swelling around the incisions; this is normal. However, call your health care provider if you have a consistent temperature above 100.5 degrees Fahrenheit, excessive swelling, redness, bleeding or increasing pain.
A follow-up appointment will be scheduled about 2 weeks after your surgery. Your surgeon will assess the wound site and your recovery, and will provide further guidelines about your activity and diet at this time.
For More Information
If you have any questions or concerns, please call us at 216.444.6996. We will be happy to answer your questions.