Wednesday, July 6, 2011

The Surgery

A rough idea of the table
Obviously I was asleep for this part of the story (and I recall having some really good dreams-it didnt seem like I was asleep that long). I'm about to get a little nerdy and borrow heavily from the internet as to what occurred when I was asleep. It's too bad I don't have access to the fancy doctor site Dr. S showed me because it was clear and concise in its explanations. I'll try to simplify some of the surgery highlights. There is also a video here "not-so faint of heart". I haven't watched it yet but I am sure its interesting. It's important to remember that the steps involved in the surgery are plus or minus what is done, but that at various stages every surgeon would do things a little differently. Even the incision points can vary.

The Surgery

A warming blanket is placed on the patient to maintain core body temperature. The patient is positioned carefully for optimal surgical exposure (in this case on my right side and the bed itself curves-see photo), and IV antibiotics are given prior to surgical incision. IV hydration is critical to optimize blood flow to the remaining kidney; so normal saline is administered to maintain adequate hydration. A cathedar is inserted and urine output  is carefully monitored.

In my case, two small ports were used-oner in the upper abdomen and the other in the lower abdomen, closer to hip level. A third, longer incision about 6-7cm long was made about 1cm to the left of my navel. They pump your abdomen full of CO2 to create more working space (pciture your belly growing to about the size of a 5-6 month pregnant woman).

The left-sided approach avoids the need for liver retraction and often provides a longer renal artery and vein (so its easier-they have more to work with). They basically get the kidney to a point where it is easily accessible. And then they pause. Using the laproscopic equipment, they move the other surrounding organs "out of the way" tying them back somewhat (the spleen, the colon and any other nearby friends).

Dr. S told me that at that point they put me on hold for a bit-upwards of an hour. The recipient would be in a likely adjoining room. Their surgeon(s) begin the process of getting their patient ready to receive the kidney. Truthfully I am not sure what is involved there. The reason for the pause for the donor at this point is that they need to make sure while doing the preparations on the recipient , no other medical/surgical issues arise that would put the transplant in jeopardy. For example if the patient is reacting badly to the anaesthesia or is having heart issues, they don't want to take my kidney out and then not have the ability to complete the transplant. So they get me ready, then get that person ready, assess everyone is doing okay and then take the donor kidney.

Once the go ahead is given, the donor surgeon works to detach the kidney from things like the adrenal gland, the bladder and eventually the renal vein and artery (in my case I just had one of each so it was easy-peasy and "unremarkable" according to Dr. Y). A special vascular stapler is used, freeing the kidney for removal.

It basically sounds like they then insert a bag using the scope into the larger incision at my navel-the bag springs open, they scoop up the kidney and pop it out, all contained in the bag. I assume at that point they put it in some kind of container and take it over to the recipients operating room where the rest of the magic happens.

At that point they check for bleeding and using dissolving sutures/stitches close up the small ports and the larger incision. On the surface they use steri-strips (aka butterfly stitches) which are essentially little pieces of tape that hold small wounds/incisions together as they heal.

After that, the patient is moved from the table back to their hospital bed (this is where I woke up-I remember it pretty clearly) and off they go to the recovery room. There a nurse monitors the patients vitals, administers pain medicine if needed (it was but not terribly). In my case, she reminded me to keep breathing a few times, but not the "special fancy yoga breathing people do these days". At first I didnt really like her-she seemed kind of gruff but after awhile I realized it was more that she was trying to make sure I was okay and that you have to sound gruff when you are reminding people to keep breathing.

The pain, as I mentioned, was definitely there but not horrific. It was more discomfort-an achy pull on my left side. The upper small incision hurt the mist. My stomach felt bloated and looked large. I wasn't in a ton of pain unless I had to move. Case in point, my favourite part of the recovery room was when they needed to do a portable chest x-ray which involved sitting up straight so they could get a panel behind me while I was half asleep. Even with one or two people helping get me up, it really sucked. My abs raged at me. It was thankfully over in no time and once I was back lying down the pain subsided. I am not sure if the x-ray is standard or if they had a particular concern with me. I know they want to be sure your lungs don't collapse because of pressure on your diaphram from the gas they pump in. Anyway one thing I did find very helpful with the pain were warm blankets they put on my stomach-a definite must have for anyone getting abdominal surgery.

Overtime I became more alert although I was still struggling to stay awake. Every time I'd glance at my recovery nurse she'd ask what I needed. I told her I was just looking at her and she told me she is there to watch me not the other way around. I think I called her a lurker. She at least laughed at that. Soon thereafter she made a comment that I was ready to go back to my room and that they needed to make room as there were a "lot of kidney flying around today). They moved me to a different part of the room to wait for purple porters. The nurse did one last check to see if I needed anything. I said I didn't. She smiled, adjusted my pillow a bit, leaned over and whispered "You did a really wonderful thing you know". 

 I thanked her and fell asleep.

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