A Perfect Match:
New Surgical Technique Minimizes Recovery Time for Kidney Donors

This year, Nancy Easom’s Valentine’s Day gift from her husband came a week late, but it was exactly what she wanted – an organ transplant.

"Forty-seven years ago I gave her my heart – this year I gave her my kidney," James Easom said. "We were high-school sweethearts, and I always knew we were a good match."

Patients donating kidneys, like Easom, can now return to work and family life faster and with less pain, thanks to a minimally invasive technique for kidney removal performed in Houston only by surgeons at Memorial Hermann Hospital. To date, the surgery has been done successfully in four donor-recipient combinations.

The procedure, known as laparoscopic donor nephrectomy, is performed by Dr. Stephen Katz, a Memorial Hermann transplant surgeon and UT-Houston Medical School associate professor, along with Memorial Hermann and UT-Houston laparoscopic general surgeons Drs. Bruce MacFadyen and Terry Scarborough.

Dr. Katz said he hopes the ease of recovering from the procedure will increase the number of people willing to consider donating a kidney.

"With laparoscopic nephrectomy, the physical recovery toll on the donor is greatly reduced," Dr. Katz said. "It means less time in the hospital, light duty for the first week home and resuming normal activity by approximately two weeks."

Before the introduction of laparoscopic nephrectomy, the standard method for removing a kidney was called open nephrectomy, whereby a surgeon would position a kidney donor on his or her side, then make a large incision through the flanks. The kidney was removed through the incision.

With laparoscopic nephrectomy, the patient is positioned on his or her back. The transplant surgeon then makes a very small 6- to 8-centimeter incision in the abdomen, through which the kidney will be removed. A second surgeon, a laparoscopic surgeon, then makes a tiny hole adjacent to the incision, and inserts a laproscope – a tube with a miniature camera attached – into the hole. The camera broadcasts images of the patient’s abdomen to a video monitor in the operating room, while the transplant surgeon’s skilled hand enters the abdomen through the incision and finds its way to the kidney, ultimately retrieving it for a transplant patient. All the while, the transplant surgeon’s other hand operates a cauterizing tool called a harmonic scalpel which is passed through a second tiny hole into the abdomen to close off bleeding vessels, making this surgery virtually "bloodless."

In a variation of this method, tools, instead of the surgeon’s hand, can be used to retrieve the kidney, but Dr. Katz prefers the hand-assist method, since five fingers and a surgeon’s tactile touch offer finer control that is more "in touch" with the patient’s anatomy than surgical tools.

Laparoscopic nephrectomies result in shorter recovery times and reduced hospital stays – about 2.5 days compared to 4.5 days with the open nephrectomy. Laparoscopic patients also report less pain, and a sense of complete recovery, compared to the open procedure.

"I had my operation on a Wednesday and by Thursday I was off all pain medication," said Easom, who was eager to attend to his wife after surgery. "A week later, I was getting around fine with virtually no pain and my wife’s feeling much better, too. The whole procedure was as smooth as glass."

Dr. Katz predicts that laparoscopic nephrectomies will become the standard for live kidney transplantation in the near future.

"Because it takes longer to retrieve a kidney with laparoscopy, the kidney doesn’t function quite as well in the short term compared to those removed by open nephrectomy, but their function at six months and beyond are identical," Dr. Katz said. "That’s why we have chosen to adopt the procedure at Memorial Hermann Hospital."

While the laparoscopic procedure now takes from three to six hours to perform, Dr. Katz said he expects the time to decrease with experience, eventually approaching the 90 minutes to three hours required for a standard open nephrectomy.

"It has been exciting to see our patients recover more quickly without sacrificing kidney function in the recipient," he said. "The day we performed our first case, we also had an open case scheduled at another location. In comparing the two patients, there was a striking difference in each patient’s recovery."

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©2006 Texas Medical Center

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