March 31, 1999
Living donors can now donate a kidney using laparoscopic surgery
The decision to donate a kidney to a family member or friend in need of a transplant is never easy. Apart from other considerations, the procedure has traditionally involved major surgery and lengthy recuperation for the donor.
Transplant surgeons hope a new minimally invasive surgical technique for removing a kidney from a living donor — called laparoscopic nephrectomy — will encourage more people to consider making this gift of life.
UW Medical Center has performed 14 of the new surgeries in the last year. The transplant surgeon on all the cases, UW Assistant Professor of Surgery Dr. Lucile E. Wrenshall, also performed laparoscopic kidney retrieval at the University of Minnesota before she came to the UW. She is routinely assisted by Dr. Jim Porter, a laparascopic urologic surgeon.
“The traditional open surgery requires at least a nine-inch incision,” said Wrenshall. “In contrast, the laparoscopic technique uses one three- to four-inch incision and three tiny incisions through which the instruments are inserted.”
As a result, patients need less pain medication following surgery and can typically leave the hospital in three days, versus five days for those who have open surgery. They are able to resume household activities in about a week and return to work in about two weeks, compared to five or six weeks’ recovery time after open surgery.
The minimally invasive procedure is not appropriate for all donors, said Wrenshall, but can be utilized in about 90 percent of cases. Such factors as obesity and severe back problems may necessitate open surgery.
“The surgery is covered by the recipient’s insurance,” said Wrenshall, “but for people concerned about loss of income from missing work, the shorter recovery time after donating is a major benefit.”
Wrenshall will discuss laparoscopic kidney removal during the 1999 Patient Conferences sponsored by the Northwest Kidney Centers, on Saturday, April 10, at the Embassy Suites Hotel, Tukwila. A woman who donated a kidney to a friend last year will also talk about her experience. (For information on the conference, call {206} 292-2771.)
The UW transplant program performed 20 living-donor transplants last year (16 from relatives and four from unrelated donors), and has performed four to date in 1999.
A comparison of laparoscopic and open kidney removals performed at the University of Maryland (which has performed the technique since 1996) showed that laparoscopy produces the same positive results as open surgery, in terms of survival of the donated kidney. The big advantages to the donor were in reduced blood loss, shorter hospital stay, less need for narcotic pain medication, earlier resumption of normal diet, and quicker return to normal activity (Annals of Surgery, Vol. 226, No. 4, pp. 483-490).
National statistics compiled by UNOS, the United Network for Organ Sharing, tell of the compelling need for more living kidney donors. More than 40,000 people being kept alive by kidney dialysis are currently listed on the kidney-transplant waiting list. In 1996, the most recent year for which statistics are available, there were just 3,553 living donors and 5,417 cadaver donors.
“We hope that, as people learn of this less invasive option for kidney removal, more people will consider becoming living donors,” said Wrenshall.
“The UW has become a training center for laparoscopic surgeons from throughout the region, thanks to Dr. Carlos Pellegrini, who chairs the Department of Surgery, and Dr. Mika Sinanan, who directs the UW Center for Videoendoscopic Surgery,” said Dr. Christopher Marsh, who heads the UW kidney transplant program. “This expertise has been applied to many areas, including transplantation. We are dedicated to providing cutting-edge technology and the best outcomes for our patients.”
