A less-invasive, laparoscopic technique allows people to donate a kidney with much less pain, a shorter hospital stay, and a much faster recovery. Surgeons at the University of Maryland Medical Center also have found that kidneys removed in this less-traumatic way function as well as those taken out with a large incision.
After two years, 98 percent of the kidneys removed from donors with the less-invasive technique continued to function well in transplant recipients, compared to 96 percent that had been taken out previously with the traditional, "open" operation. Also, with current removal techniques, the complication rate in kidney recipients is lower than the rate among those whose new kidney was taken from the donor with a large incision.
This data, from the University of Maryland Medical Center's first 193 kidney donors to have the laparoscopic removal, will be presented on July 14 in Montreal at the 17th World Congress of the Transplantation Society by transplant surgeon Benjamin Philosophe, M.D., Ph.D.
The University of Maryland Medical Center has performed the most laparoscopic kidney removals in the world, in more than 220 patients since March 1996.
Another study looked at the impact on everyday life among the medical center's first 125 laparoscopic kidney donors.
"With the laparoscopic approach, our kidney donor patients stay in the hospital an average of three days instead of four and a half days with the standard operation, and they return to work an average of four weeks sooner, in 20 days rather than 47 days," says Eugene Cho, M.D., who presented the findings at the Society of American Gastrointestinal Endoscopic Surgeons in Seattle in April. Dr. Cho is co-director of the laparoscopic live donor nephrectomy program at the University of Maryland Medical Center.
In addition, his study found that donors who have the laparoscopic technique only require post-surgical pain medication for an average of 30 hours compared to 60 hours with the traditional method. They resume driving three times sooner and doing housework in less than half the time.
Both studies compared the laparoscopic group to transplant patients with similar characteristics, such as age, sex, and other factors, and found no difference in kidney function and between the kidneys removed laparoscopically and those taken out in the traditional type of operation.
"This new procedure has made a big difference for our kidney transplant patients and their loved ones who donate a kidney," says Stephen T. Bartlett, M.D., director of the division of Transplant Surgery at the University of Maryland Medical Center.
"Since we began the laparoscopic kidney removal program in March of 1996, our percentage of living donor kidney transplants has increased significantly, from about 30 percent of all kidney transplants to 50 percent. One reason is that our kidney transplant patients feel better about receiving the donation knowing that the donor's recovery will be much faster with the new technique," says Bartlett.
The medical center's kidney transplant program is among the five busiest in the U.S. and the largest in Maryland, having performed 226 kidney transplants during 1997. Of those, 118 were from living donors, and all but eight of the kidneys were removed laparoscopically.
"Living kidney donation is extremely important, because there is a critical shortage of organs for the thousands of patients who need transplants," says Dr. Bartlett. According to the Transplant Resource Center of Maryland, about 39,300 people are on waiting lists nationwide for a kidney transplant. About 1,400 are waiting in Maryland.
The laparoscopic kidney removal surgery is very challenging to perform, especially since it requires keeping the kidney in excellent working condition.
"It is the most difficult type of laparoscopic procedure and should only be performed by surgeons with a high degree of technical skill and considerable laparoscopic experience," says Jack Flowers, M.D., director of Laparoscopic Surgery at the University of Maryland Medical Center. Dr. Flowers was a member of the University of Maryland team that performed the first laparoscopic gall bladder removal in the Northeastern U.S. in September 1989.
"Even though this laparoscopic procedure has been met with a great deal of initial success and patient satisfaction, there is a learning curve associated with all technically difficult procedures, and patients should look for experienced surgeons," says Dr. Philosophe.
With the laparoscopic technique to remove a kidney, surgeons only need to make a small incision at the navel, about two-and-a-half inches wide, as well as four small holes in which they insert instruments. The laparoscope contains a miniature camera and surgeons watch what they are doing on a video monitor. When the kidney is disconnected, they wrap it in a plastic bag and slide it out of the small incision at the navel. The traditional, "open" surgery to remove a kidney requires an incision of about ten inches long, which cuts through abdominal muscles and takes a long time to heal.