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Laparoscopic Donor Nephrectomy 

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

At Penn State Milton S. Hershey Medical Center, Randy Haluck, M.D., director of minimally invasive surgery, is 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 anastomosis 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.