Monday, July 9, 2007

Laparoscopic donor nephrectomy

Laparoscopic donor nephrectomy refers to a minimally invasive procedure to remove a kidney from the donor. I have observed 2 living donor kidney donations in which laparoscopic donor nephrectomy was performed concomitantly with the actual kidney transplant. The laparoscopic part was actually very cool 1) because of its semi-r0botic nature and 2) it is projected on the screen so I didn't have to strain to see it.

This procedure is performed through two or three 1/2 - inch puncture sites. With the patient under general anesthesia during the procedure, the surgeons make 1/2 - inch incisions. Laparoscope containing a video camera is introduced through one port, with its image projected onto a monitor so that the surgeons can see and control activity through the abdomen. Carbon dioxide is introduced to inflate the abdominal cavity(insufflation) to provide working space. The other 2 ports accommodate devices to perform the actual procedure such as staple gun. Once the organ(kidney) has been excised, a 2 -inch incision under the bellybutton is made to provide a path for extraction of the donated kidney. It is really neat to watch. Somehow the surgeon manages to slide in a plastic bag onto which the kidney is placed before it is taken out through the 2-inch incision. This is whole procedure is done by observing projected images on the monitor.

a) Excision of renal vein from

This state-of-art procedure, as compared to open kidney donation, has several advantages. First and most importantly, the smaller incision shortens postoperative hospital stay (usually two days), minimizes post-op discomfort, has less risk of hernia and scar formation, is more cosmetic and speeds up the patient's complete return to normal activity (2 wks compared to 6 for open surgery). Second, t
his procedure is much quicker than the old 12-inch long muscle splitting incision; it is a 2-hr operation. Lastly, the procedure doesn't require the detachment of the diaphragm, and therefore minimizes the risks of infectious disease such as pneumonia.

I thought this procedure was a textbook example of how technology has revolutionalized medicine. Watching the surgeon maneuver around several organs( intestines and and the spleen) to reach the kidney was not only astounding but also gave me a great appreciation of Anatomy and its mastery. All that said, it nonetheless left with me one lasting distaste. When the scope is inserted into the belly, the stomach and the organs become vividly visible including the yellow, disgusting fatty adipose around the stomach lining.. It is GROSS!


No comments: