History of Laparoscopic Live
Donor Nephrectomy Drs. Lloyd Ratner and Louis Kavoussi, were
the first to perform laparoscopic live donor nephrectomy at Johns
Hopkins in 1995. Over the last several years Johns Hopkins Hospital
has developed one of the largest series of laparoscopic donor nephrectomy
cases around the world. When compared to the conventional open donor
surgical technique, laparoscopic donor nephrectomy has resulted
in significantly less post operative pain, a shorter hospital stay,
earlier return to work and daily activities, a more favorable cosmetic
result, with recipient outcomes identical to the open procedure.
General Information As a candidate for kidney donation, our foremost
goal is to provide you, the donor, with the safest and most effective
means of organ removal to ensure successful kidney transplantation
to your friend or loved one. Laparoscopic donor nephrectomy is a
minimally invasive technique of kidney donation, which provides
the least amount of discomfort for the donor while maintaining the
health and quality of the kidney for transplantation.
Laparoscopic live donor nephrectomy
is a surgical procedure that is performed by both urologist and
transplant surgeons at Johns Hopkins.
For appointments please callthe number listed above.
In the event of an emergency
and you need to contact someone in the evening hours or on
the weekend, please call the paging operator at
410-955-6070 and ask to speak to the urologist
For appointments with the Transplant Surgeons call the Transplant
Office at 410-955-5045
In the event of an emergency and you need to contact someone
in the evening hours or on the weekend, please call
the paging operator at 410-955-6070
and ask for the Transplant Coordinator on call.
For directions to Johns Hopkins
PRIOR TO THE SURGERY
What to expect prior to the surgery
All potential donors undergo extensive medical
and psychological evaluation ensuring that the donor will
maintain normal kidney function following surgical removal
of the kidney intended for donation. The following tests are
necessary prior to donating your kidney:
Blood Work -
There are several routine blood tests to assess your blood
count, blood type, kidney function and general health. Tissue
typing is also done through a blood test to assess the degree
of genetic similarity between the donor and the recipient.
Your blood will also be tested for many other diseases including
Hepatitis and HIV.
Other routine testing include:
Electrocardiogram (EKG), chest X-ray, urinalysis, a stool
test that can be done at home to check for blood in your
stool, and a 24 hour urine collection.
3D CT Scan of the abdomen and
pelvis - This is a sophisticated three- dimensional
X-ray, which provides anatomical detail of the size, shape
and blood vessels of the kidneys. All kidney donor candidates
undergo a 3D CT to determine which kidney is the most suitable
Female patients - will
need a gynecological exam and a pregnancy test. A mammogram
is necessary for women older than 39.
Male patients - older
than 39 will need to have a blood test called a PSA (prostate
specific antigen) to assess for prostate problems including,
prostatitis, prostate cancer and enlarged prostate.
Psychological Evaluation -
is done to ensure that the donor has a full understanding
of his / her role in the transplant process.
Final Cross Match
- This is done through a blood test. You, along with the
recipient, will have to have your blood tested within one
week of the transplant to assure compatibility. If for any
reason this test comes back positive, the surgery will have
to be cancelled. There may be other options that the transplant
team will discuss with you.
Medications to Avoid Prior to Surgery
Aspirin, Motrin, Ibuprofen,
Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox,
Celebrex, Voltaren, Vioxx, Plavix and some other arthritis
medications can cause bleeding and should be avoided
1 week prior to the date of surgery (Please contact
your surgeon’s office if you are unsure about which
medications to stop prior to surgery. Do not stop any medication
without contacting the prescribing doctor to get their approval).
Bowel Preparation and Clear Liquid
Do not eat or drink anything after midnight the night before
the surgery and drink one bottle of Magnesium Citrate (can
be purchased at your local pharmacy) the evening before
Drink only clear fluids for a 24-hour
period prior to the date of your surgery. Clear liquids
are liquids that you are able to see through. Please follow
the diet below.
Clear Liquid Diet
Remember not to eat or drink anything after
midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through.
Please follow the diet below.
Clear Broths (no cream soups, meat,
Juices (no orange juice or tomato
Apple juice or apple cider
Tea (you may add sweetener, but no cream
Coffee (you may add sweetener, but no
cream or milk)
Clear Jello (without fruit)
Popsicles (without fruit or cream)
Italian ices or snowball (no marshmallow)
Laparoscopic donor nephrectomy is performed
under a general anesthetic. The typical length of the operation
is 3-4 hours. The surgery is performed through 3 small (1cm)
incisions made in the abdomen. A telescope and small instruments
are inserted into the abdomen through these keyhole incisions,
which allow the surgeon to completely free and dissect the
kidney without having to place his hands into the abdomen.The
kidney is then placed within a plastic sack and removed intact
through either a horizontal or lower midline abdominal incision.
The following is a series
of video clips that demonstrate key steps of a laparoscopic
nephrectomy for removal of a left kidney tumor.
these video clips include footage from an actual surgery which
some viewers may find difficult to watch.
Although this procedure has proven to be
very safe, as in any surgical procedure there are risks and
potential complications. The safety and complication rates
are similar compared to open surgery. Potential risks include:
loss during this procedure is typically minor (less than
100 cc) and a blood transfusion is needed in less than 5%
of patients. If you are interested in autologous blood transfusion
(donating your own blood) prior to your surgery, you must
make your surgeon aware .
Infection: All patients
are treated with intravenous antibiotics, prior to starting
surgery to decrease the chance of infection from occurring
after surgery. If you develop any signs or symptoms of infection
after the surgery (fever, drainage from your incisions,
urinary frequency/discomfort, pain or anything that you
may be concerned about) please contact us at once.
Hernia: Hernias at
incision sites rarely occur since all keyhole incisions
are closed carefully at the completion of your surgery
Tissue / Organ Injury:
Although uncommon, possible injury to surrounding tissue
and organs including bowel, vascular structures, spleen,
liver, pancreas and gallbladder could require further surgery.
Injury could occur to nerves or muscles related to patient
positioning on the operating room table
Conversion to Open Surgery:
The surgical procedure may require conversion to the standard
open operation if difficulty is encountered during the laparoscopic
procedure. This could result in a larger standard open incision
and possibly a longer recuperation period.
Failure of Transplanted
Kidney: A potential
risk for the recipient is the possibility that the kidney
may not function or will be slow to function.
WHAT TO EXPECT AFTER
During your hospitalization
Immediately after the surgery you will
be taken to the recovery room and transferred to your hospital
room once you are fully awake and your vital signs are stable.
Pain medication can be controlled and delivered by the patient
via an epidural, or an intravenous catheter or by an injection
(pain shot) administered by the nursing staff. Once on a
regular diet, pain medications may be taken by mouth, instead
of by IV or shots. You may experience some minor shoulder
pain (1 -2 days) related to the gas used to inflate your
belly during the laparoscopic surgery. Transient testicular
pain can occur, but is uncommon.
Nausea: You may experience
some nausea related to the anesthesia. Medication is available
to treat persistent nausea.
Urinary Catheter: You
can expect to have a urinary catheter draining your bladder
(which is placed in the operating room with the patient
asleep) for approximately one day after your surgery. It
is not uncommon to have blood-tinged urine for a few days
after your surgery.
Intravenous Catheter: You
can expect to have an intravenous catheter (IV) in for 1-2
days. (An IV is a small tube fed into your vein so that
you can receive necessary fluids and stay well hydrated;
in addition it provides a way to receive medications).
Fatigue: Fatigue is
common and should start to subside in a few weeks.
Prevention of Blood Clots: You
can expect to have SCD's (sequential compression devices)
along with tight white stockings on your legs to prevent
blood clots from forming in your legs.
You will be expected to do some very simple breathing exercises
to help prevent respiratory infections through using an
incentive spirometry device (these exercises will be explained
to you during your hospital stay). Coughing and deep breathing
is an important part of your recuperation and helps to prevent
pneumonia and other pulmonary complications.
Walking: On the first
day after surgery it is very important to get out of bed
and begin walking with the supervision of your nurse or
a family member to help prevent blood clots from forming
in your legs.
Diet: Most patients
are able to tolerate ice chips and small sips of liquids
the day of the surgery and regular food the next day.
Length of Hospital Stay:
The length of hospital stay for most patients is approximately
You may experience sluggish bowels for several days following
surgery as a result of the anesthesia. Suppositories and
stool softeners are usually given to help with this problem.
Taking a teaspoon of mineral oil daily at home will also
help to prevent constipation. Narcotic pain medication can
also cause constipation and therefore patients are encouraged
to discontinue any narcotic pain medication as soon after
surgery as tolerated.
What to expect after discharge
from the hospital
Bathing: You may shower
at home. You may shower after returning home from the hospital.
Your wound sites can get wet, but must be padded dry immediately
after showering. Tub baths are not recommended in the first
2 weeks after surgery as this will soak your incisions and
increase the risk of infection. You will have adhesive strips
across your incisions. They will fall off in approximately
5-7 days on their own. Sutures underneath the skin will
dissolve in 4-6 weeks.
Activity: Taking walks
is advised. Prolonged sitting or lying in bed should be
avoided. Climbing stairs is possible but should be taken
slowly. Driving should be avoided for at least 1- 2 weeks
after surgery. Absolutely no heavy lifting (greater than
20 pounds) or exercising (jogging, swimming, treadmill,
biking) for six weeks or until instructed by your doctor.
Most patients return to full activity at home on an average
of 3 weeks after surgery. You can expect to return to work
in approximately 4 weeks.
Preventive Care: You
should see your family doctor or primary care physician
yearly for a routine check up and for blood tests to determine
the function of your remaining kidney.You should take special
care of your remaining kidney by avoiding any type of contact
sport, which can cause damage to your remaining kidney.
You should be on a no added salt diet and should always
avoid high protein diets.
Postoperative Visit: You will need to call
the office of your surgeon soon after your discharge to schedule
a follow up visit for 4 weeks after your surgery date.