A nephrectomy is the removal of a kidney, and a laparoscopic donor nephrectomy is a newer, better way to remove a healthy kidney for transplant into another patient. Years ago, the only way to remove the healthy kidney for donation was through a large incision and removal of a rib in the side of the body through the abdominal muscles. This incision was painful, required a long healing time, and caused a variety of complications.
Today, surgeons offer donors a more effective, less painful approach for kidney harvesting. Using a laparoscope, doctors make a small cut (about an inch long or less) and insert a camera into the body that allows them to see in real time the organs and internal structures of the body on a television screen in the operating room. This scope also utilizes small tools that make it possible to disconnect a healthy kidney and prepare if for removal through an incision lower on the abdomen. This minimally invasive disrupts fewer muscles or structures of the body compared to traditional methods, allowing donors to heal more quickly, lose less blood, and experience less pain.
To remove the kidney, a sterile needle is inserted into the abdomen for inflation and to make more room for the instruments. About the diameter of a pencil, the laparoscope is inserted through incisions in the upper left side of the abdomen and the surgeon inspects the inside of the abdominal cavity before beginning the procedure. If everything looks normal, two more small incisions are made in a line below the first so instruments can be used during the surgery. Once the kidney is free, it is removed from the body through a 7 centimeter cut below the belly button or in the bikini area.
Most kidney donors are eligible for a laparoscopic nephrectomy unless they are significantly overweight, have a history of multiple abdominal surgeries, or if kidney structures are abnormal. Some donors may be able to leave the hospital the day of surgery and others may stay 1-2 days depending. As with any surgery, food and liquids will be advanced slowly staring with clear liquids moving up to solid food as tolerated. Donors will be encouraged to move and walk, but must follow activity restrictions on lifting for 2 to 4 weeks.
Incisions will be covered with small adhesive covers and also stitched from the inside out. Donors will be able to shower normally and will not need to do anything with the dressings. However, the site should be monitored for signs of infection, drainage, swelling or redness and any fever should be reported to the treating physician. Donors can expect to follow up with their surgeon about 2 weeks after the procedure.
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