Laparoscopic Live Donor Nephrectomy

WHAT YOU SHOULD KNOW:

• Laparoscopic (lap-ah-ROS-ko-pik) live donor nephrectomy (ne-FREK-to-me) is surgery to remove a kidney and transfer it to someone with serious kidney problem. The kidneys are two bean-shaped organs found under the ribs on each side of the upper abdomen (stomach).
  
  
• The kidneys remove wastes and other unwanted chemicals from the body. These wastes are flushed from the body in the form of urine. When the kidneys are badly damaged, these wastes build-up in the body and cause harm. These harmful wastes may cause dizziness, headache, seizures, confusion, fainting, or even death. A new kidney may be needed to replace the damaged kidney to keep the body working. The kidney you give can help a person with serious kidney disease live longer.
  
  
• You may give your kidney if you are in good health and between 18 and 70 years old. You must be well informed of what may happen and have carefully thought about willingly giving a kidney. You will be checked to make sure that you will be OK living with only one kidney. Your caregiver makes small incisions (cuts) on your side where a laparoscope and other tools are inserted. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives your caregiver a clear view of the abdominal area while watching the images on a screen. Your caregiver uses these tools to carefully remove your kidney. With laparoscopic surgery, you may heal faster, feel less pain, and have smaller scars.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are always risks with surgery, such as infection or bleeding too much. You may have trouble breathing. Problems may happen during your laparoscopic surgery that may lead to an open surgery. Nerves, blood vessels, muscles, intestines, and other organs may be damaged. The gas used during the surgery may cause shoulder or chest pain for 1 to 2 days after your surgery.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: Giving a kidney is a serious decision, and you must think about it very carefully. No one should force or pressure you to give your kidney and you must be giving it willingly. Your caregiver will tell you what will happen before, during, and after surgery in words that you know. You will be told what tests, treatments, or procedures may need to be done. Your caregiver will tell you the risks of going through this surgery. He will also tell you what benefits the person receiving your kidney may get. Even if you already said that you are giving your kidney, you have the right not to go through with it. Before giving your consent, make sure all your questions have been answered and that you understand what may happen.
  
  
• Enema: You may need to have an enema before your surgery. This is liquid put into your rectum to help empty its contents.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
    
    
  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
    
    
  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• General anesthesia: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up.
  
  
• Tests:
  
  
  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
    
    
  • Computerized tomography scan: This is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen. It may be used to look for abnormal changes and problems with your kidneys.
    
    
  • Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
    
    
  • Magnetic resonance imaging: This is also called an MRI. During the MRI, pictures of your abdomen are taken. An MRI may be used to check around your kidneys for other problems.
    
    
  • Renal arteriography: Renal arteriography is done to check for problems with blood vessels in your kidneys. Your caregiver uses a special dye to help blood vessels show up better on x-ray pictures. Tell your caregiver if you are allergic to iodine or shellfish (lobster, crab), as you may also be allergic to the dye used for this test.
    
    
  • X-rays: Before surgery, caregivers may want to have an x-ray (picture) of your abdomen to see any other problems with your kidneys.

During your surgery:

You are turned to your side after you go to sleep. Your skin is cleaned and then covered with clean sheets. Your caregiver makes 3 to 5 small incisions (cuts) where the laparoscope and other instruments will pass through. Your abdomen is filled with gas (carbon dioxide) to lift the abdominal wall away from the internal organs. Blood vessels are clamped, tied, or cut, and your kidney is removed. Your caregiver may also make a larger incision during the surgery. He may use his hand, together with the special instruments, to do surgery in the abdomen. The kidney will be removed from your body through this larger incision. Your caregiver will check for other problems before closing the incisions with stitches (threads) and covering them with bandages.

After your surgery:

You may be taken to a recovery room until you are fully awake. Caregivers will watch you closely for any problems. Do not get out of bed until your caregiver says it is OK. When caregivers see that you are OK, you will be taken back to your hospital room. The bandages used to cover your stitches keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your surgery to check your wounds.

• Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.
  
  
• Food and drink after surgery: You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  
  
• Drains: These are thin rubber tubes put into your skin to drain fluid from around your incision. The drains are taken out when the incision stops draining.
  
  
• Medicines: You may be given the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
    
    
  • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.
    
    
  • Stool softeners: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.