What is Laparoscopic Surgery?
Laparoscopic surgery is performed by inflating the abdomen with gas, usually carbon dioxide, which creates a space between the wall of the abdomen and the organs inside.
Using short incisions in the skin, narrow tubes are inserted through the abdominal wall so that instruments can be slid through them to perform the maneuvers necessary for the operation. All this is viewed directly on a video monitor which receives its picture from a video camera attached to the laparoscope.
Using these techniques, operation on the gallbladder, stomach, intestines, kidney, and other organs is possible.
Laparoscopic Kidney Removal
Using narrow instruments inserted through tiny punctures no more than a ½ inch long it is now possible for the surgeon to free up the kidney and tie off the blood vessels. A short incision about 2 ½ inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost (see diagram below). The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.
The Operation
Four or five tiny incisions are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is scooped up in a bag and extracted from the abdomen through a short incision (5 in above diagram) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It is usually removed within a few days.
Benefits to the Donor
The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized.
Risks for the Donor
All operations carry some risk. Those which are the most important for you to know about are mentioned here.
Most of the complicated laparoscopic procedures which we perform require full general anesthesia to allow enough relaxation of the muscles of the abdominal wall so that the operative space to work in is large enough. Modern anesthesia is very safe and the anesthesiologists at USC are all highly skilled, board certified physicians. Naturally they will need to be fully informed of any medical disorders that you may have or problems with anesthesia in the past. It is especially important that if you have any heart problems, your regular physician can send copies of old EKGs and information about any other tests that you may have had.
Any operation can be complicated by bleeding and infection. If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months or years later. Thrombosis and pulmonary embolus (clots to the lungs) are an ever present risk. It has been our experience that these complications are much less frequent after laparoscopic than conventional surgery.
Even in traditional surgery, each operation has a specific complication that every surgeon strives to avoid. These potential pitfalls are still present when the operation is performed laparoscopically and will be outlined to you, depending on the type of procedure you require.
Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional open procedure is for your safety.
Alternatives
Most live donors come to us for laparoscopic surgery, although we have an extensive background in traditional surgery. Much of the discussion of alternative forms of treatment will have taken place before coming to see us. If we feel that your best interests will not be served by laparoscopic surgery we will tell you so and suggest an appropriate alternative.
Complications
It is rare for there to be problems due to the surgery. Bleeding during or after surgery is the chief complication and is minimized by careful technique. Low blood pressure and faintness may be signs of bleeding and should be evaluated by the surgical team.
Because the operation is performed alongside other organs it is theoretically possible that an injury could occur to one of them. Persistent pain, fever, nausea or vomiting should be notified to the surgeon.
Admission and Discharge
Admission takes place two hours before the planned procedure. The donor operation takes 3-4 hours and the recipient operation lasts about 3 hours. In addition, the time necessary for anesthesia before and after operation may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress.
You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home the next day, or the day after depending on how comfortable you are.
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