Laparoscopic kidney removal performed as donor procedure
BY MIKE GOODKIND
Stanford surgeons on April 29 performed the Bay Area's first donor kidney removal using a technique known as laparoscopic live-donor nephrectomy. The minimally invasive procedure enabled the donor, 26-year-old Mario Ricardez of San Jose, to help save his sister's life with relatively little disruption of his own.
Surgeons who use the laparoscopic technique are able to avoid extensive cutting of muscles and nerves by instead inserting narrow tubes through four small holes, or ports, in the abdomen, said Ricardez' surgeon, Dr. Howard N. Winfield, associate professor of urology.
"The benefit for the donor is the potential to leave the hospital and return to work more quickly, more comfortably," Winfield said. "We don't have to cut through as many muscles and nerves as we do with conventional surgery to reach the kidneys. Early results indicate that it is safe and the organs are transplanted just as successfully. And if for any reason we need to, we can instantly convert to the traditional procedure [during the operation]."
Both Mario Ricardez and his sister, 36-year-old Martha Ricardez who had suffered total kidney failure because of an autoimmune disease called lupus left Stanford Hospital on May 2 and were recovering well this week.
"It was a perfect match. Her new kidneys began functioning immediately," said Martha's surgeon, Dr. Donald C. Dafoe, associate professor of surgery.
The donor procedure uses tiny laparoscopic instruments inserted through the tubes. Surgeons cut away the kidney from surrounding tissue, leaving only the major blood vessels to feed the organ until the last possible moment. Next they staple shut, and then sever, the blood vessels. Immediately the surgeons insert a retractable synthetic sack through one of the ports. The sack captures and sweeps up the kidney much as a butterfly net collects an insect.
The kidney, compressed but fully intact, is then removed through one of the ports enlarged to about 1.75 inches and rushed to the waiting recipient.
For more than four years, surgeons have used laparoscopic techniques to remove diseased kidneys, Winfield said, but the April 29 operation marked the first time surgeons in the Bay Area have put together the skills and resources needed to remove a donor kidney intact healthy and ready to be transplanted. The donor procedure was developed about three years ago by surgeons at Johns Hopkins University Medical Center in Baltimore, where Winfield learned to use the technique. A surgeon from Hopkins assisted in the April 29 procedure.
Most kidney donors at Stanford should be able to opt for the laparoscopic procedure unless their anatomy is too complicated to allow surgeons a "clean shot" at the organ, Winfield said.
Ricardez is expected to be back on his job as a maintenance technician at Palo Alto's Cable Coop about three weeks after surgery less than half the time typically needed for a kidney donor to return to work. He stayed in the hospital four days, which is comparable to the usual stay for kidney donors. In the future, Winfield said, the laparoscopic procedure may allow many donors to leave the hospital after only two or three days.
The Ricardez siblings were selected for the first local use of the new procedure, Dafoe said, because Mario was worried about having to miss work and the surgeons believed the less invasive operation would get him back on the job sooner.
"And my sister encouraged me because she didn't want me to feel much pain," Mario Ricardez said. "Now I'm happy. There should be no more dialysis for my sister."
"The benefit is not so much that the wound is smaller which it is but that the surgery is less invasive," Winfield said. "In a traditional donor procedure, we make a six-inch cut through muscle and nerve tissue. In the new procedure, the largest of four port openings, usually made through the umbilicus, or belly button, generally limits nerve and muscle injury, making the technique far less invasive and far more comfortable."
While operating, surgeons look at an overhead TV monitor to guide their instruments inside the body. This technique, called videolaparoscopy, is used today for a variety of procedures, including most U.S. gallbladder procedures. Winfield has been using it for nearly six years to remove diseased kidneys, but in those cases it doesn't matter if the organ is damaged during the removal, he noted.
The new donor procedure takes a little longer than traditional surgery about four hours rather than three, Dafoe said.
"Donor procedures are unique in
medicine, because we are asking a healthy individual to undergo an
invasive medical procedure for the benefit of someone else," said
Dafoe. "It's important that we continue to find better procedures,
and this is an excellent step." SR