Laparoscopic Donor Nephrectomy
The potential to increase the number of organ
donors
In spite of public awareness campaigns
promoting organ donation, the number of patients
eligible for renal transplantation consistently
exceeds the supply of suitable cadavaric donor
organs. Dialysis can assist renal function for
the majority of patients waiting for a donor
organ to become available. However, renal
dialysis does not promote a good quality of life
and there is an inverse relationship between the
length of time a patient remains on dialysis and
the long-term viability of the donor organ
following transplantation. Organ donation from a
living relative or friend provides one solution
to the organ shortage. Perioperative morbidity to
the donor, one barrier to living organ donation,
may be mitigated by the surgical technique,
laparoscopic donor nephrectomy.
Facts
- Laparoscopic donor nephrectomy has been
performed at Penn State Milton S. Hershey
Medical Center since 1999. Hershey was among the
first wave of institutions to adopt this new
procedure.
- A study of 38 living donors who underwent
nephrectomy using the traditional approach
comparing outcomes with 15 living donors whose
kidneys were removed via laparoscopic surgery
showed no difference in recipient allograft
function. The length of stay following
laparoscopic donor nephrectomy was significantly
less than that for the patients who underwent an
open procedure.
- Other benefits to laparoscopic donor
nephrectomy include less postoperative pain for
the donor, better cosmesis, shorter recovery
time and faster return to normal activities.
- Most centers that have laparoscopic programs
see an increase in the number of people willing
to donate a kidney.
Experience improves service and outcomes
Edward Alfrey, M.D., chief of the section of
renal transplantation, established the
laparoscopic donor nephrectomy program while he
was director of the adult kidney and
kidney/pancreas transplantation program and
attending transplant surgeon at Stanford
University School of Medicine. At Penn State
Milton S. Hershey Medical Center, he joins Randy
Haluck, M.D., director of minimally invasive
surgery, in offering this service to people with
end-stage renal disease.
Facts
- Currently, surgeons at other institutions
strongly favor the left kidney for laparoscopic
donation. When the left kidney is found to be
suboptimal for donation, usually because of
normal anatomic, Dr. Haluck performs
laparoscopic excision of the right kidney with
equal success.
- Between May 1999 and January 2000, 15 living
donor nephrectomies (eight right kidneys and
seven left kidneys) were performed at Penn State
Milton S. Hershey Medical Center. There was no
incidence of delayed graft function or acute
tubular necrosis in either group and no
significant decrease in serum creatinine levels
one day pre-operatively, at discharge, or the
three months after surgery.
Laparoscopic nephrectomy and
autotransplantation
Laparoscopic nephrectomy and subsequent
autotransplantation presents a novel way of
treating unusual anatomical structures and
symptomatic kidney pathology in the presence of
normal kidney function. At Penn State Hershey
Medical Center, a series of patients underwent
laparoscopic nephrectomy and autotransplantation
to correct anatomical abnormalities or to
mitigate intractable symptoms. Extraction of the
kidney and transplantation in an anastomsis in
the retroperitoneal space were realized through
the same incision.
Facts
- Creatinine levels at the time of discharge
were equivalent to the preoperative values.
- There was resolution of hematuria immediately
following autotransplantation.
- Patients experience minimal discomfort.
- A shorter hospital stay.
- Patients recover more quickly.
- One small incision yields a better cosmetic
result.
The benefits of a multidisciplinary team
An aneurysm that develops on the distal end of
the renal artery requires in vivo repair. Two
surgeons, Randy Haluck, M.D., and Robert Atnip,
M.D., chief, Division of Vascular Surgery, along
with other members of the transplant team, remove
such an aneurysm by excising the patient’s left
kidney laparoscopically. Dr. Haluck, who directs
the Medical Center’s Minimally invasive Surgery
Program, made three small ports to locate and
release the kidney. The organ was removed via a
small incision and Dr. Atnip removed the aneurysm
and reconstructed the arterial vasculature. The
kidney was reimplanted on the left side of the
patient’s pelvis.
By combing the surgeon’s skills with that of
the transplant team, the patient spent less time
in the hospital and had a faster recovery than
would have been the case if the kidney had been
removed via an open procedure.
Your patients should know
Laparoscopic renal excision is the preferable
surgical option. Otherwise, there is extensive
abdominal surgery. Very few patients are not
candidates for this procedure.
For appointments, call (717) 531-6092 or (800)
525-5395
Physician's Who Perform Laparoscopic Donor
Nephrectomy
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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