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Related Article
An Easier Kidney Transplant
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| Surgeon Ernesto Molmenti with kidney patient Justin Shane, who is exploring living donor transplantation. |
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Living donor kidney transplant has been a blessing for many patients who don't have access to cadaveric organs, for cultural, religious or other reasons. But the post- operative pain and prolonged hospitalization associated with the surgery has pushed many prospective donors away.
A much less-invasive operation pioneered at Hopkins, however, has minimized the pain and shortened the recovery time signifi-cantly for donors."There's a minimal scar, less discomfort for the patient, less time in the hospital and a faster return to normal activities," says surgeon Ernesto Molmenti, M.D. "Also, it's a more-aesthetically pleasing result because you don't have the large flank incision used in the open surgery."
In the laparoscopic approach, first performed by Hopkins surgeons Louis Kavoussi, M.D., and Lloyd Ratner, M.D., in 1995, three tiny incisions are made in the abdomen, through which tubes for a camera and surgical instruments are placed. Using the camera to guide them, the surgeons then inflate the abdomen and begin dissecting the kidney, taking special care not to injure surrounding structures.
"The challenge is to be able to remove the organ safely, preserving its viability without injuring adjacent organs, the colon, spleen, small intestines, vessels like the aorta and vena cava," says Molmenti. Most injuries are avoided through experience, he adds, noting that Hopkins surgeons perform over 100 living donor kidney transplants each year.
After vessels like the adrenal and renal arteries and veins are carefully clipped and divided for hook-up in the recipient, freeing the entire kidney, Molmenti feeds a bag through one of the portals to capture the organ. He then makes a small C-section incision in the patient's abdomen, and pulls the bag through the opening.
All of the blood in the donor kidney is flushed out of the organ to reduce the risk of clotting after it's implanted in the recipient. Molmenti then wraps the kidney in an ice blanket as another team of surgeons begins to connect the donor organ to the recipient's renal vessels. Molmenti notes that there is significantly less "ischemic time"-the amount of time the organ is preserved in ice between removal and implant-in living donor transplants, and, consequently, fewer complications.
How effective is the procedure? In the first 110 laparoscopic kidney transplants at Hopkins, length of hospital stay, pain medicines, complications and readmission rates were significantly lower than those of open-surgery patients. Molmenti says, "It has really become the standard of care in most centers."
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