Laparoscopic Technique May Encourage More People To Donate Kidneys
(Chicago, IL)-- A new, laparoscopic technique allows people to donate a kidney with much less pain, a shorter hospital stay, and a much faster recovery. Also, kidneys removed in this less-traumatic way function as well as those taken out with a large incision, according to surgeons from the University of Maryland Medical Center in Baltimore.
Results from a one-year study of the procedure in 70 patients will be reported by University of Maryland surgeons at a joint session of the American Society of Transplant Surgeons and the American Society of Transplant Physicians in Chicago on May 14. The University of Maryland Medical Center has performed the most laparoscopic kidney removals in the world, in 81 patients so far.
"With the laparoscopic approach, our kidney donor patients stay in the hospital an average of 2.2 days instead of 4.5 days with the standard operation. They return to work an average of five weeks sooner, in 16 days rather than 51 days," says Stephen Jacobs, M.D., professor of surgery and head of Urology at the University of Maryland Medical Center.
In addition, donors who have the laparoscopic technique only require post-surgical pain medication for an average of 27 hours compared to 60 hours with the traditional method. They resume driving and doing housework in two-thirds less time.
Using the laparoscope, surgeons only need to make a small incision at the navel, 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 navel. The traditional, "open" surgery to remove a kidney requires an incision of about ten inches long, which cuts through abdominal muscles and takes a long time to heal.
"The incidence of complications and average time spent in the operating room are similar with both types of surgery, but the laparoscopic group experiences one-third of the amount of blood loss, on average," says Jack Flowers, M.D., director of Laparoscopic Surgery at the University of Maryland Medical Center.
The researchers find no difference in kidney function between the kidneys removed laparoscopically and those taken out in the traditional type of operation. They compared the laparoscopic group to transplant patients with similar characteristics, such as age, sex, and other factors.
"With an average follow-up time of 8 months, 97 percent of the kidneys taken out laparoscopically continue to function, compared to 98 percent with the older method." says Dr. Jacobs.
"This new procedure has made a big difference for our kidney transplant patients and their loved ones who donate a kidney," 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.
"Since we began the laparoscopic kidney removal program in March of 1996, our percentage of living donor kidney transplants has increased significantly, from about 30 percent of all kidney transplants to 44 percent. We believe one reason is that our kidney transplant patients feel better about receiving the donation knowing that the donor's recovery will be much faster with the new technique," says Bartlett.
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. Nationwide, 10,892 kidney transplants were performed in 1995. Of those, 3,209, or about 29 percent, were from living donors.
"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 1,100 are waiting in Maryland.
In their study, University of Maryland surgeons found that the average medical cost of laparoscopic kidney removal was $12,000, about $500 more than the standard type of operation. The shorter hospital stay with the new technique was offset by the cost of the laparoscopic supplies, which increase the price of the procedure by about $1,400.
However, when the researchers figured in the greater loss of productivity during the long recuperation from the standard procedure, they found the laparoscopic technique saves almost $5,000 for each working donor and employer. "From that standpoint, there is a large net cost benefit to society from the laparoscopic method," says Dr. Jacobs.
The laparoscopic kidney removal surgery is very challenging to perform, especially since it requires keeping the kidney in excellent working condition. Dr. Jacobs and Dr. Flowers caution that it is the most difficult type of laparoscopic procedure and should only be performed by surgeons with a high degree of technical skill and considerable laparoscopic experience.
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.
Other members of the research team were Dr. James Lim, Dr. Eugene Cho, Dr. Eugene Schweitzer, Dr. Paul Kuo, Dr. Lynt Johnson, and Dr. Jeffrey Plotkin.
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 home.