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Living Donor Kidney Center

Surgery, Recovery & Donor Health Maintenance

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The types of surgery that living kidney donors undergo to remove their kidney has evolved significantly over the past 50 years. In this section, we will review the different types of surgery, the typical recovery period for today's living kidney donors, and the things donors can do to maintain their health long into the future.

Open Donor Nephrectomy

An open donor nephrectomy was the only option for removing a donor's kidney from the 1950's to the mid-1990's. This surgery occurred under general anesthesia and involved a 6 to 10-inch incision on the front and side of the abdomen, which requires cutting through several layers of muscle to access the kidney being removed. This surgery required a much longer recovery period compared to current laparoscopic procedures. Today, it is rare to perform open nephrectomies for the sake of kidney donation. Rarely, laparoscopic procedures must be "converted" to an open procedure due to complications such as bleeding.

Laparoscopic Donor Nephrectomy

Laparoscopic donor nephrectomy is minimally invasive surgery that utilizes instruments such as a camera (videoscope) and tools (instruments) to remove the kidney on long, narrow rods that are placed into the abdomen through small incisions. The videoscope and surgical instruments are maneuvered through three or four small incisions in the abdomen. Carbon dioxide is pumped into the abdominal cavity to inflate it, which helps the surgeon to see and maneuver better. Once the kidney is freed, it is secured in a bag and pulled through an incision that is about 3 inches long and is several inches below the umbilicus (belly button).

Laparoscopic donor nephrectomy has several benefits over open nephrectomy, including faster recovery time, shorter hospital stay, and less post-operative pain.

Another laparoscopic technique called hand-assisted laparoscopic nephrectomy may also be used to remove the kidney. In this procedure, one of the incisions is slightly larger to be able to accommodate the surgeon's hand, which allows the surgeon to use one hand to feel the kidney and surrounding areas. Once freed, the kidney is then removed by hand through the incision.

Laparoendoscopic Single Site Donor Nephrectomy

In 2008, a new modification of the laparoscopic donor nephrectomy began to be utilized at some transplant centers. During the procedure, the donor surgeon(s) uses a single entry port through the patient's navel (belly button) to safely dissect the kidney from its surrounding attachments, using a laparoscopic camera and instruments. This same incision is then used to remove the kidney for transplantation. No incisions outside the belly button are needed. The graphic below shows the incision used for the single port nephrectomy.

This exciting technological advancement is the latest innovative step in providing a less invasive surgical option for kidney donors. It may represent an improvement in the standard laparoscopic technique, which requires three or four tiny incisions as well as a three-inch incision to remove the organ. So far, this operation has been performed with minimal risk and excellent outcomes. Being able to accomplish the same procedure safely through a single natural opening in the belly button may help donors recover faster and have an improved cosmetic result.

The Weill Cornell Transplant Program was the first center in New York to perform a laparoscopic single port kidney removal through the navel for a living donor kidney, and has quickly become a national leader in performing this surgical innovation. Our donor team remains dedicated to being on the cutting edge of minimally invasive surgery to best serve our very special kidney donors, and are performing several research studies to determine the best procedure for our donors.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Donor Nephrectomy

A newer procedure was reported in the medical literature beginning in 2010. As an alternative to the 3-inch incision needed to remove the donor kidney during a conventional laparoscopic donor nephrectomy, some centers are offering transvaginal extraction of the kidney for female donors. It is not yet known if the risks and benefits of this procedure are equivalent to a conventional laparoscopic donor nephrectomy.

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