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Traditional Open Surgery
In traditional open surgery, often a portion of the last rib was removed during a donor nephrectomy. However, in recent years, this procedure has been replaced by mini-incision live donor (MILD) nephrectomy and laparoscopic donor nephrectomy. These two procedures reduce the recovery time in the hospital, the time to full recovery and the chance of wound complications.
MILD: Mini-Incision Live Donor Nephrectomy
With this procedure the kidney is removed from an incision on the front of the abdomen. The 3-4 inch incision extends from the tip of the lowest rib toward the belly button.
Less Invasive, Laparoscopic Surgery
Some donors may qualify for an alternate procedure, the laparoscopic donor nephrectomy. This surgical approach takes approximately three to four hours.
In order to perform a laparoscopic donor nephrectomy, 3 to 4 small incisions are made. The abdomen is inflated with a gas that allows movement and separation of the abdominal organs. Surgical instruments and a laparoscope are inserted through the small incisions, which allows the surgeon to maneuver around the organs and see and remove the kidney. The kidney is removed through a small incision above the pubic area.
The advantages of the laparoscopic technique are:
- A shorter hospital stay
- Decreased need for pain medication
- Earlier return to activities of daily living
- Earlier return to work
- The complication rate has been reported to be slightly higher than that of the traditional open donor nephrectomy. Some have reported a higher incidence of surgical damage to the blood vessels and ureter.
- The requirement for blood transfusions has been slightly higher for those undergoing the laparoscopic procedure.
- It has also been reported that the recipient's risk of delayed kidney function is higher due to decreased blood flow to the kidney when gas is placed in the abdomen, and the trauma to the kidney when it is removed from the small incisions. This may lead to a slow return of kidney function when the kidney is transplanted into the recipient. If this does occur, the recipient is not able to start normal doses of immunosuppressive medication as quickly, which may account for higher incidence of rejection of the kidney after surgery.
The complication rate has reportedly decreased over the past three years as transplant surgeons have gained more expertise with the laparoscopic procedure.
Donors who do not qualify for the laparoscopic procedure, will have the traditional, open surgery. The surgeon will be able to discuss surgical options in detail during the office visit. There are advantages and disadvantages to both procedures.
A review of the Rhode Island Hospital experience shows nearly identical outcomes for the MILD and laparoscopic donor nephrectomy techniques. Your surgeon can offer further details about the best approach for your operation.