Laparoscopic Surgery

Open surgical live donor nephrectomy is a standard method for obtaining healthier kidneys for transplantation. We now offer an alternative technique called laparoscopic live donor nephrectomy. This is the removal of the kidney using narrow instruments placed through several small incisions after inflating the abdomen with gas. Our experience with this technique suggests that it reduces post operative pain and the period of recovery, since the procedure is performed through several small incisions rather than through a single large incision on the side of the body. Our own studies suggest that on average there is less pain for the first weeks after a laparoscopic nephrectomy compared to the standard open procedure. Individuals vary greatly in their response to surgery, however, such that in some patients the recovery from laparoscopy has taken longer than for most open surgeries and conversely for some patient having open surgery their recovery has been more rapid than for most laparoscopic procedures.

Because the kidney has to be removed intact for the recipient, we do make a 2 to 3 inch incision, either around the belly button or in the pelvic area depending on a number of considerations. This is in addition to the 2 to 4 incisions on the donor's side for the laparoscopic instruments, each of which measure an inch long. In terms of the surgery that goes on inside, the laparoscopic procedure is basically the same as the surgery performed through an open incision - although it does take about an hour and a half longer to perform. The incision of the open procedure is 4 to 8 inches long, on the donor's side.

Laparoscopic nephrectomy for both kidney donation and other reasons (cancer, infections, etc.) is a routine procedure at the University of Michigan. Nonetheless, there are limitations. If the patient is significantly overweight or has had prior surgery in the abdomen they may not be eligible for laparoscopy. The laparoscopic live donor nephrectomy appears to provide an excellent kidney for the recipient, similar to that of the open procedure. In the largest studies published to date of this procedure, from the University of Maryland only 6 of 320 kidneys were lost. We have performed more than 200 laparoscopic live donor nephrectomies, and feel confident offering it routinely to most potential kidney donors. Donors will have the opportunity to discuss the advantages and disadvantages of laparoscopy versus open nephrectomy with a surgeon at the time of the donor's evaluation.