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Friday, November 5, 2010

Just the Facts M'am...Surgery 101

Still waiting on the booklet and forms from the Southern Alberta Transplant program but I thought I'd share some online facts that I found (from Living Donors Online).  I am really curious if the standard in Canada is to scope or do whats called an open nephrectomy (see below for the difference).  Hopefully the booklet will discuss that-if not I'll ask.  The recovery times are obviously hugely different



  • Open nephrectomy: This procedure, which is the older form of surgery, involves making an incision of several inches—as long as 10 inches—from the left side (assuming the left kidney is taken) along the bottom of the lower rib to the midriff.
    There is an alternative open nephrectomy procedure that begins the incision further on the back along the side to the front (a flank incision), but a portion of the rib may have to be removed. You may be offered a choice between these alternatives.
    Regardless of the alternative, the incision requires cutting through three layers of muscle. Once access to the kidney is gained, the arteries and ureter are clamped off. The kidney is removed, flushed, and placed in a cold preservative solution. You may receive a blood transfusion during the operation, but such transfusions are rare.







  • Laparoscopic nephrectomy: This procedure uses a laparoscope—a device inserted into the abdomen allowing the surgeon to see and operate. This technique involves making several small (a couple of inches each) incisions in your abdomen, called "ports," to allow insertion of a laparoscope and other instruments. The camera and instruments are used to cut the kidney away from surrounding tissue after clamping off the arteries and ureter. The kidney is removed through an incision below your belly button. Then you're closed up.

    Note that donation of the right kidney is more complicated because the liver is in the way, therefore an incision may be made in a different area of your abdomen.





  • Donor Postoperative Recovery (Average)


    Open

    Laparoscopic

    Hospital stay (days)5.52.9
    Able to return to full activity (weeks)6.23.2
    Actual return to work (weeks)6.34.4
    Drive a car (days)22.213.5


    Medical Risks of Living Donation Surgery

    There are risks to the donor during and after the surgery. Unlike most other surgeries, you--the patient--are actually in excellent health when undergoing surgery. Therefore, the risks are attributable primarily to the surgery itself and the removal of a kidney. These risks are small and manageable, but in the interest of full disclosure, here are some of the possible complications and consequences:
    • Pain. This is a certainty, and it is one aspect of donation that donors tend to underestimate. Fortunately, pain is managed through medication after surgery.
    • Complications. About 10% to 30% of donors report some form of complication following surgery. The complications include infection of the incision, minor bleeding, urinary tract infection, and pneumonia.

      One special complication of laparoscopic nephrectomy reported on LDO is feeling bloated. This happens because the abdomen is inflated with gas during the surgery to give the surgeon more room to manipulate the laparoscope and surgical tools. It takes a while after the surgery for the body to eliminate the gas, so the donor can feel uncomfortable for a while. LDO donors report that walking and being active helps to speed the elimination of the gas.
    • Reoperation.Some complications may be significant enough that you need to go back into surgery. Research shows reoperation occurs in 2% or less of donations. Examples of the kinds of major complications that require reoperatoin include hernia, bleeding, bowel obstruction, and bowel injury.
    • Readmission. You may have problems after you leave the hospital that require you to return to the hospital.  About 2% of donors return to the hospital because of ailments like nausea, vomiting, bleeding, constipation, diarrhea, and infection.
    • Death. It happens. Fortunately, it is exceedingly rare. The generally accepted rate of mortality risk is 0.03% (that's three deaths for every 10,000 procedures.)

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