sages donor nephrectomy

8/7/2019 SAGES Donor Nephrectomy

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Laparoscopic Donor Nephrectomy

(donating a kidney to a friend orfamily member who needs a kidney

transplant)

A simple guide to help answer your questions


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What are your kidneys?

The kidneys are twofist-sized organs,about 4 inches long.

They are located inyour back, aboveyour waistline, andare protected byyour ribs.


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What functions do your kidneys perform?

They balance thebody's salt and watercontent.

They remove wasteproducts from theblood. Wasteproducts come frombody cells and foodsthat are eaten.

They help keep bodychemicals in balance.


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What happens when your kidneys donot function normally?

Many diseases can affect kidney function.When your kidneys are not functioningnormally, the bodys ability to remove wastes,

balance the salts in your blood, and removeexcess fluids from the body is affected. Mostof the time your doctor can treat this withmedicines and a special diet. If function ofthe kidneys continues to decline however,

hemodialysis (a machine which filters theblood) may be necessary. Complete kidneyfailure occurs when less than about 10% ofyour kidneys functions are working.


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What happens when your kidneys do notfunction normally?

When your kidneys fail, toxins andwaste products from foods and bodycells, as well as extra fluids build up inthe blood. If the excess wastes andfluids are not removed, you will becomevery ill. Some of the symptoms of

kidney failure are swelling, confusion,feeling tired, and difficulty breathing.


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What happens when your kidneys do notfunction normally?

In addition to filtering the blood, thekidneys also secrete chemicals which

help produce red blood cells, makevitamin D, and assist with calciumregulation. If the kidneys are failing,

anemia (low blood count) and weak andfragile bones can result.


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What can cause Kidney Failure?

Many diseases can affect the kidneys,but a few are responsible for themajority of kidney failure

High Blood pressure

Diabetes

Glomerulonephritis (a disease that causesscarring of the kidney)

Lupus (a disease where the body attacksitself)


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What is kidney failure and how is ittreated?

Kidney failure is treated based on the amountof kidney function

When the amount of failure is mild or

moderate, then medications to assist withremoval of fluids and balancing the salts inthe blood are given

When the amount of failure is severe or

complete, it is necessary for a specialmachine to filter the blood several times perweek to remove toxins.


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This filtering process is called dialysis. Thereare two main technique for dialysis

Hemodialysis the blood is directly filtered bypumping it out of the body and through aspecial machine

Peritoneal Dialysis a special catheter (tube)

is placed into the abdomen (belly) throughwhich fluid is instilled. The fluid absorbs thebodys waste products and then is drainedfrom the belly


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Hemodialysis

Hemodialysis is performed

for several hours several

times per week. Patients

go to dialysis centers or

hospitals where specialdoctors called

nephrologists treat them.

The patient is connected to

a machine which removesthe blood, cleans it, and

then returns it to the

patients body.


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Hemodialysis

Although hemodialysis is very effective,patients who require this treatment have a

decreased life expectancy (life span) andfrequently have complications related todialysis. In addition, the quality of life isdecreased due to the amount of time that the

individual must be in the hospital for dialysisand medical care


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Another treatment option is a KidneyTransplant. This is a procedure which takes a

healthy kidney from one individual and placesit into the body of another individual who issuffering from complete kidney failure. Thelong term results of kidney transplant as well

as the overall lifestyle appear to be betterthan dialysis.


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What is a kidney transplant?

A kidney transplant isan operation performedby a transplant surgeonin which a healthykidney from one personis placed into the body

of another personwhose kidneys are notworking.

A kidney transplantallows the recipient (the

one whose kidneys arenot working) to regainnear-normal kidneyfunction and stopdialysis treatments.


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Where does a donor kidney come from?

A kidney which is transplanted must be wellmatched for blood and tissue types betweenthe donor (the person who gives the kidney)and the recipient (the person who receives

it) so that the body doesnt reject it. Ifrejection occurs, the transplanted kidney willdie and dialysis will be necessary again. Agood match is much more likely to occurbetween blood relatives than between non-related individuals (because of the geneticsimilarity)


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Kidney Transplant

There are 2 methods of obtaining kidneys forkidney transplants

Cadaveric where a kidney is taken from

someone who has chosen to be an organ donorafter they die or are declared brain dead (such asin a car accident or traumatic injury)

Donor Directed usually either a close relative(living related donor) or friend (living unrelated

donor) who specifically donates one of theirkidneys to someone who is suffering from kidneyfailure


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Kidney Transplant

Unfortunately, there are far fewer donorkidneys than individuals who need them.Many people still die each year waiting for

kidney transplants. Over the course of thelast 8 years, the number of donor directedand living related kidneys has steadilyincreased. One of the reasons for this is that

this operation to obtain the donor kidney cannow be performed using Laparoscopicsurgery (small incisions and minimal pain andscaring).


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Kidney Transplant

In a donor directed or living relatedtransplant, the normal functioningkidney must be surgically removed fromthe donor (without harming them) sothat it can be transplanted into theindividual who is suffering from kidney

failure.


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Kidney Transplant

A good example

of a healed open

incision whichwas used to

obtain the kidney

to betransplanted

Open incision


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Kidney Transplant

A good example ofthe healed incisionsafter a laparoscopic

surgery to obtainthe kidney to bedonated. Notice thesignificant differencein the incision sizeand the bettercosmeticappearance.

Incisions from surgery to donate

kidney


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How is laparoscopic donor nephrectomyperformed?

Using a video camera system andtelescope, small incisions are madeallowing specially trained surgeons to

remove a viable functioning kidney froma living donor.

The procedure can be performed eithercompletely laparoscopically or hand-assisted (use of a small incision toinsert the hand into the abdominalcavity).


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Is it safe to remove someones kidney?

The body does not need 2 kidneys only one(or sometimes less) is necessary to maintainnormal body functions

The individual who donates a kidney should

not notice any perceptible difference after thekidney has been removed

(SIMPLY PUT YES, IT IS SAFE!)


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Laparoscopic donor nephrectomy(removing the kidney from the donor)

Using very smallincisions, a specialtelescopic camera and

specially designedinstruments, thekidney is removedfrom the donor. Thesurgeon performs the

surgery while lookingat a TV monitor


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What is hand-assisted laparoscopic donornephrectomy?

In the hand-assistedversion, anadditional, horizontal

3-inch incision ismade across thelower abdomen, justabove the pubic

bone (similar to a C-section incision).

InchIncisions

3 InchIncision


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Hand-assisted donor nephrectomy

The hand-assistedtechnique allow the

surgeon to place hishand inside theabdomen (belly) toassist with the

surgery.

InchIncisions

3 Inch

Incision


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Hand-assisted laparoscopic donornephrectomy

Using the handallow for easier

removal of the intactkidney from thedonor.

Surgeons Hand

In Patient


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What are the advantages of hand-assistedlaparoscopic donor nephrectomy?

Better exposure andcontrol

Allows tactile dissection

Better control ofbleeding

Less time kidney iswithout blood flow

Faster operating times

Shorter learning curve


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Donor nephrectomy what is done withthe kidney after it is removed?

Once the kidney isremoved, it isflushed with apreservative solutionand prepared to beplaced into the

recipient by thetransplant surgeon


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Donor nephrectomy - what is done withthe kidney after it is removed?

The kidney is thentaken to anotheroperating room

where it isimplanted into therecipient. Theincision for

placement of thenew kidney is in thegroin


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Donor nephrectomy - what is done withthe kidney after it is removed?

The newtransplanted kidneyis connected to the

recipients artery,vein, and urinarybladder. Mostrecipients kidney

function returns tonear normal withinabout a week.


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Who can donate a kidney?

The person who wishes to donatemust be in good health. The suitabilityof the donor depends on:

the donor wanting to donate a kidney the donor having normally functioning

kidneys

a good tissue match between thedonor and recipient so that the kidneywill not be rejected by the recipient.


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Who can donate a kidney?

In addition, donorswill have to undergotests to determine

the anatomy of theblood supply to theirkidney. This willusually be a special

MRI, but can be aCAT scan or anarteriogram

MRI angiogram of the renal

blood vessels


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What preparation is necessary to donate akidney?

Medications such as aspirin, Motrin,Aleve, ibuprofen and other anti-

inflammatory drugs should be stopped7-10 days before the day of surgery.These drugs can cause bleeding during

surgery and can also decrease thefunction of the kidney.


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What is the recovery time after Idonate a kidney?

The hospital stay for the donor is usually 5-7days after an open operation. If the

operation is done laparosopically however,donors can usually go home within a day ortwo after surgery. The pain and discomfortare significantly decreased with a

laparoscopic procedure. Most patients can beback at work within 2 weeks and at a normal

level of activity within 4 weeks.


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What is the recovery time after a laparoscopickidney donation?

1-2 day hospital stay

2 weeks off work 4 weeks off strenuous activity and

heavy lifting


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Facts about live-directed donornephrectomy

35.6% of all kidney transplants weredonor-directed kidney transplants(12,488) in 1999

Have better kidney function andsurvival compared to the cadaveric typeof transplant

Greater than 90% success rate forLiving Related donor transplants 2 yearsafter their surgery


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Advantages of Laparoscopic versus OpenLiving Donor Nephrectomy

Less pain

Shorter hospital length of stay

Faster recovery time Faster time to return to work

Improved cosmetic results

Higher rate of organ donation


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What are the risks to this procedure?

Risks are small, but definitely need to beconsidered prior to undergoing surgery

Wound infection Wound hernia (bulge) Wound seroma (fluid collection) Bleeding Bowel obstruction and internal adhesions

Conversion to open procedure Injury to an organ in the abdomen (spleen,colon, etc)

Very small chance of death (< 0.1%)


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If you have any questions or

concerns about laparoscopicdonor nephrectomy.

Contact your physician or go to the SAGES website foradditional help

www.SAGES.org

THANK YOU

sages donor nephrectomy

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