Laparoscopic
Kidney Surgery
- The Gift of a Kidney
- Suitability for Donation
- Conventional Surgery
- Laparoscopic Kidney Removal
- Admission and Discharge
- The Operation
- Benefits and Risks
- Complications
Your decision to donate one of your kidneys is a wonderful gift of life and health but it is essential that your own health is not jeopardized.
You may be a candidate for surgical removal of a kidney (or nephrectomy) by a form of minimally invasive surgery called laparoscopy. This brochure will explain many of the requirements of selection for donation and answer some of the questions you may have concerning laparoscopic surgery.
We know that it is possible to lead a perfectly normal life with one normally functioning kidney. From the moment that the donated kidney is removed the remaining one will take over and in time it will grow in size. There are no symptoms that result from this adaptation.
Each
kidney receives blood, usually from a single large artery, clears
out waste products to be excreted in the urine and sends the blood back
through a large vein. The waste in the form or urine is pumped
from each kidney to the bladder by the ureter. The left kidney
is preferred for donation because the vein is longer, making implantation
in the recipient easier. If the blood vessels or ureter on the left are
unsuitable, then the right kidney can be used.
Figure 1: Blood
from the aorta goes through the renal artery to the
kidney where it is filtered and sent back through the renal vein (arrowed)
via the vena cava to the heart.
If you are in good health with normal kidney function, and no infections or other disorders which may affect or be affected by the removal of a kidney you could be a donor. The suitability of the blood vessels of your kidney for donation is determined with a Magnetic Resonance (MRA) scan, which shows the blood vessels and ureters. This is performed in hospital as part of the evaluation procedures. Dye injected into a vein flows with the blood into each kidney and is recorded on film.
Regular donor nephrectomy requires a long incision with removal of a rib, to allow the surgeon access to the kidney, blood vessels and ureter. Hospitalization of about 5 days is necessary. Nonetheless this operation has been performed thousands of times, providing a safe, reliable way of removing the donated kidney.
Using narrow instruments inserted through tiny punctures no more than a 1/2 inch long it is now possible for the surgeon to free up the kidney and tie off the blood vessels. A short incision about 21/2 inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost (see Figure 2). The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.
Figure 2: 1-4 mark the punctures for surgery to the left kidney. 5 is the position in a female for an incision below the bikini line to remove the kidney.
Admission is two hours before the planned procedure. The surgery takes about 3 hours. In addition, the time necessary for anesthesia before and after the surgery may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress.
You will be allowed to drink a few hours after you wake up and will start solid food the next day. Return of bowel function can be slow so return to a normal diet must be cautious. You may be able go home the next day, or the day after depending on how comfortable you are.
Four or five tiny incisions (1-4 in Figure 2) are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is collected in a bag and extracted from the abdomen through a short incision (5 in Figure 2) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It will be removed the next day.
Laparoscopic kidney removal is a new version of an already established operation. You can expect much less pain, hospitalization of 1-2 days and return to normal activity in around 1-2 weeks.
The risks of surgery are chiefly related to anesthesia, bleeding, and the potential for injury to the kidney or other organs during the procedure. Our chief concern is for your safety so that if at any time we encounter a problem that cannot be solved during the laparoscopy then the procedure will be converted to regular surgery.
It is rare for there to be problems due to the surgery. Bleeding during or after surgery is the chief complication and is minimized by careful surgery.
Thromboembolism (or clots in the veins) is a rare complication after kidney donor surgery. Vigorous measures are taken to avoid this including compression leggings during surgery and, most importantly, getting out of bed and moving soon after surgery.
