LOS ANGELES (July 6, 2000) -- When 38-year-old Alta Loma, CA, resident Darlene Navarrete learned that her 29-year-old cousin, Holly Miyagawa of Hermosa Beach, needed a donated kidney to save her life, Darlene didn't hesitate to offer one of hers. But unlike traditional living kidney donations, which require a long incision and a major "open" operation, Darlene's kidney was removed through a "mini incision" (a small port) and she was back to work at the City of Los Angeles Planning Department in about a week.
Known as a laparoscopic live donor nephrectomy, the procedure, which is available at only a few transplant centers in the nation, was performed at Cedars-Sinai Medical Center by Gerhard J. Fuchs, M.D.
When Holly was born, she had only one fully functioning kidney. One healthy kidney is sufficient to sustain a normal life, and Holly's performed well enough for her to maintain an active life that included beach volleyball, in-line skating and running on the beach whenever time allowed.
But when doctors discovered several years ago that the healthy kidney was starting to slowly deteriorate, they began to monitor her health more closely.
"I've always been very active and I started noticing a lack of energy around October and November (1999). I just couldn't figure out what was wrong," says Holly. "I didn't go to the doctor yet because I thought maybe I was just fighting a cold. Then my legs started swelling. That was the sign that my kidney was failing."
By December, Holly needed dialysis treatments to cleanse the impurities from her blood and assume the other life-sustaining activities that healthy kidneys normally perform. Her mother and brother hoped they might donate a kidney to Holly but when medical tests in January found that they would not be good candidates, more distant family members volunteered to undergo testing.
Darlene turned out to be an excellent candidate, and the transplant operations were performed at Cedars-Sinai on March 6.
"When I came out (of surgery), I was in recovery and I was in no pain at all. I didn't take any pain pills," says Darlene. "They came in and asked me if I needed any medication for pain and I didn't. I had surgery on a Monday and I went home Tuesday afternoon. I was in there about 24 hours. They gave me a prescription for pain but I didn't use any."
Within a week, Darlene's routine had returned nearly to normal. "I got home on Tuesday. They put me on a liquid diet until Thursday and by Thursday evening I could have soft foods. Then Friday I was eating a regular diet. I think Friday I was already at the mall. I was walking a little slowly but I was still there."
After the weekend, Darlene was ready to go back to work. "I was off work for six days," she says. "Everybody was amazed at work, like, 'What are you doing here?'" In contrast, a friend of Darlene's who donated a kidney in an open procedure was unable to return to work for about eight weeks.
With Darlene's "spare" kidney, Holly's life, too, is returning to normal. She went back to work at a law firm two months after the operation and is returning to her active outdoor lifestyle. Initially operating "on a much slower scale" than before, Holly expects to be back to 100 percent before long. "I still don't have quite the energy that I used to, but I'm back out on the beach. I started running a little bit, going to the gym, trying to get back what I had," Holly says.
Because many patients languish on dialysis or die while on donor organ waiting lists because potential recipients drastically outnumber supply, laparoscopic live donor nephrectomy has in recent years become a welcome option for family members and even friends of patients who need a kidney. Performed through mini-incisions and using video-assisted optics and precision instruments, the procedure dramatically reduces recovery time, risk and pain.
This "convenience" has no down side, based on data gathered from Dr. Fuchs' own experience and from the few other transplant centers that have offered the laparoscopic technique. "It does not compromise the donor's health and it does not compromise the health or viability of the kidney," according to Dr. Fuchs. "In other words, when the kidney is implanted into the recipient, it works the same way as if it had been harvested by the open surgical technique."
Dr. Fuchs joined Cedars-Sinai full time earlier this year. In addition to offering laparoscopic nephrectomy, he has become an instrumental member of the medical center's oncology program, using minimally invasive approaches to treat cancers of the prostate, kidney, bladder and other organs and structures.
One of the world's pioneers and most respected authorities in the relatively new field of endourology, Dr. Fuchs founded and directs the medical center's Endourology Institute. With his years of research and clinical experience, he uses slender, sophisticated instruments to navigate the urinary tract to reach and treat a variety of conditions without ever making an incision. This approach not only minimizes pain and recovery time, but it often can save a patient's vital organs.
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