New Technique Spares Transplant Donors Pain, Recovery Time
Could Increase Kidneys Available for Transplant
January 18, 1999
Transplant surgeons at Strong Memorial Hospital have begun using a minimally invasive procedure to remove a kidney from a living donor. The technique – known as laparoscopic donor nephrectomy – dramatically reduces trauma for the donor, and physicians expect it will encourage more individuals to become living kidney donors.
In the Rochester region, nearly 145 patients are currently awaiting kidney transplants. Strong Memorial Hospital, the region’s only transplant center, performs approximately 70 kidney transplants per year – a number limited by the availability of donor organs. "There are only two ways that we can obtain organs for transplant," said Oscar Bronsther, M.D., director of Transplant Surgery at Strong. "Most of the time, donor organs come from patients who have died, but at least one in four donated kidneys now comes from living donors, usually family members."
Patients who receive transplants from living donors have better results, with the kidney remaining viable nearly twice as long – up to 20 years. "Basically they are receiving a perfect kidney," Bronsther said. "No preservation is required because the kidney is transferred directly from the donor to the patient."
The drawback however, lies in convincing healthy individuals to donate a kidney. Potential donors must undergo a stringent screening process and painful, major surgery. "Traditionally, donors have had to endure a 12- to 18-inch incision, and often we have to remove a rib to reach the kidney," Bronsther said. "They remain hospitalized for five to seven days after the surgery and lose about six weeks of work recuperating. That’s a tremendous commitment, especially if the donor is also the family’s breadwinner."
The laparoscopic technique, pioneered two years ago at Johns Hopkins Medical Center and the University of Maryland, drastically simplies the procedure for donors.
Surgeons access the kidney by entering instruments through four small "ports," or puncture wounds in the abdomen – one near the belly button, one to the left of the belly button and two in the upper abdomen. The kidney is freed and blood vessels are closed using instruments entered through the ports. Once free, the kidney is then put into a plastic bag. Finally, surgeons enlarge the incision near the belly button to about two and a half inches, and pull the bagged kidney out of the incision. (The plastic bag makes it easier to slip the kidney out.)
Although the laparoscopic method adds a hour to the surgery, donors report less pain, are ready for discharge two days later, and can return to work in less than two weeks. "Patients are able to eat and get out of bed the following day," he said.
Bronsther is convinced that the laparoscopic procedure will soon be the preferred method for kidney donation although he cautions that it won’t work for everyone. "For anatomical reasons, it cannot be used to remove the right kidney. Also, if patients have multiple blood vessels leading into the left kidney, doctors would probably choose the traditional, open procedure."
So far, Strong’s transplant surgeons have performed laparoscopic donor nephrectomy in two cases and four more are scheduled. Doctors expect the simpler, less-traumatic surgery will increase the availability of donor kidneys. To date, the small number of the nation’s 272 transplant centers who have begun performing laparoscopic donor nephrectomy have seen the number of organs donated double, he said.