People who want to donate a kidney to a loved one can now do it with less pain, a shorter hospital stay and a much faster recovery. Surgeons at the University of Maryland Medical Center have made that possible by using a laparoscopic technique to remove the kidney instead of making a large incision.
Since March 1996, the University of Maryland Medical Center has performed the laparoscopic procedure in 68 living kidney donor transplants, more than at any other medical center in the world. In all of the cases, the transplanted kidneys were functioning well after surgery.
Using the laparoscope, surgeons only need to make a small incision above the naval, about two-and-a-half inches wide, as well as four small holes in which they insert instruments. The laparoscope contains a miniature camera and surgeons watch what they are doing on a video monitor. When the kidney is disconnected, they wrap it in a plastic bag and slide it out of the small incision at the naval. The traditional, "open" surgery to remove a kidney requires an incision of about ten inches long, which cuts through abdominal muscles.
"In our experience, kidney donors who have a kidney removed with the laparoscopic approach are able to recover much faster, in one-third less time, compared to those who have the traditional surgery," says Jack Flowers, M.D., director of Laparoscopic Surgery at the University of Maryland Medical Center. Data from the medical center's first 47 laparoscopic kidney procedures have been accepted for presentation at the American Surgical Association meeting next month in Quebec.
"With the laparoscopic method, the average hospital stay is 2.5 days instead of 4.5 days, and patients return to work in an average of two-and-a-half weeks instead of six-and a-half weeks after the traditional surgery. The incidence of complications and average time spent in the operating room are similar with both techniques, while the average amount of blood loss during surgery is about one-third less using the laparoscopic technique," Dr. Flowers says.
Dr. Flowers, an assistant professor of surgery at the University of Maryland School of Medicine, is a pioneer in using and adapting the technique. He was a member of the University of Maryland team that performed the first laparoscopic gall bladder removal in the Northeastern U.S. in September 1989. Dr. Flowers says removing a kidney while keeping it in perfect condition is the most technically challenging type of laparoscopic surgery and it should only be performed by surgeons with considerable experience.
"This new method makes it much easier for someone to donate a kidney to a loved one," says Stephen T. Bartlett, M.D., director of the division of Transplant Surgery at the University of Maryland Medical Center and professor of surgery and medicine at the University of Maryland School of Medicine.
"Living kidney donation is extremely important, because there is a critical shortage of organs for the thousands of patients who need transplants," says Dr. Bartlett. Currently, about 35,000 people nationwide are on waiting lists for a kidney transplant. More than 1100 are waiting in Maryland.
More than one-third of the kidneys transplanted at the University of Maryland Medical Center now come from living donors. The medical center's kidney transplant program is among the five busiest in the U.S. and the largest in Maryland, having performed 211 kidney transplants during 1996.
Kidney transplant patients come to the University of Maryland Medical Center from all over the country. Kidney donors and recipients who live out of town spend five nights at a nearby Baltimore hotel following their two to three night hospital stay. They return to the hospital each of those five days as an outpatient, receiving tests and medication, before returning back home.
# # #