Laparoscopic Donor Nephrectomy
Kidney failure is a very common condition worldwide and is increasing in incidence. The best treatment option for these patients is kidney transplant. For kidney transplant, the donor can either be a live person (relatives) or cadaveric organ donor. Live kidney donation offers the best outcomes in terms of life of the transplant kidney. However, live kidney donation is an altruistic procedure, in which a healthy person undergoes major surgery for the benefit of another person. Therefore, it is extremely important that the risks of the donor surgery are kept to a minimum. In this regard, laparoscopic donor nephrectomy (key-hole surgery for kidney donation) has become the standard of care procedure for kidney donation. In this procedure, small key-hole incisions are made to perform the surgery and finally the kidney is removed from a low horizontal incision, which hides below the belt- or saree-line. Laparoscopic donor nephrectomy provides optimum graft kidney outcomes while keeping the donor morbidity to the minimum. After the surgery, the donor is mostly discharged in 3-4 days.
Kidney Recipient Surgery
Kidney transplant is the best treatment option for patients with kidney failure. In this procedure, a healthy kidney is placed in the body of the recipient. The procedure involves advanced vascular reconstruction of the artery and vein of the kidney with the recipient body as well as connection of urinary system of graft kidney with the recipient urinary system. The native kidneys of the recipient are not usually removed, unless there are specific reasons to do so (life infection, large cystic kidneys, large stones etc). The surgery is done through a lower abdominal incision, although a key-hole robotic approach has recently been introduced. To ensure that the graft kidney survives within the recipient body, medicines called as immunosuppressants are given to the patient so that the recipient’s body does not reject the graft kidney. After the surgery, the patient is usually discharged in 7-8 days.
After a successful kidney transplant, these patients can live a much better quality of life compared to patients on dialysis. These patients can and have gone on to get married and have children and lead a relatively normal life.
Arterio-venous Fistula (AVF) and CAPD Catheter Placement
Arterio-venous Fistula (AVF) for Hemo-dialysis Access
Patients with chronic kidney disease require regular dialysis to ensure removal of body waste. Once the kidneys get chronically damaged and the patients lands up in end stage renal disease, long term improvement in the renal function is not possible without a renal transplant. However, till the patient get a renal transplant, regular dialysis is essential. This may be done wither via hemodialysis or peritoneal dialysis. Hemo-dialysis may be done with the help of external catheters in the jugular, subclavian or femoral vessels. However, these catheters are temporary, often getting infected and needing replacement in 3-4 weeks. The best route for hemodialysis is creation of an AVF. Hemodialysis needs presence of a superficial vessel with fast flowing blood. The arteries of the hand have fast flowing blood (but they are deep in location) and the veins of the hand are superficial (but they have slow flowing blood). Therefore, creation of an AVF entails joining an artery and vein of the hand using microsurgical vascular anastomosis technique. The AVF is usually made near the wrist of the non-dominant hand of the patient. However, due to associated vascular disease in chronic kidney patients, sometimes the vessels of near the wrist are not suitable for surgery. In this case, the AVF is made higher up in the arm or in the opposite arm. The procedure is done under local anesthesia and the patient is discharged on the same day evening of the surgery. Once successfully created, the AVF takes around 4-6 weeks to mature and only then it may be used for dialysis. Since there is no use of external catheter, the chances of infection are minimal with this technique and the long term durability is the maximum.
There are certain precautions and preparation that the urologist will ask you to take before and after the surgery for AVF –
Avoiding iv injections in the arm in which surgery is planned
Avoiding measurement of blood pressure (BP) in the arm in which surgery is planned
Do regular hand exercises with soft yellow rubber ball (available at pharmacies) to help in strengthening of vessels and maintaining proper blood flow through the vessels before and after surgery
Avoiding sleeping on the arm in which surgery is done
