 |
 |
 |
 |
Laparoscopic Nephrectomy
Please note, this page is a summary of the full conference speech (click here for the full transcript).
Professor
Michael Nicholson
Consultant Surgeon and Professor of Transplant Surgery, University of Leicester. Member of the Council of the Association of Surgeons of Great Britain and Ireland and Chairman of the Clinical Trials Committee of the British Transplantation Society.
In 1998 Professor Nicholson and colleagues in Leicester introduced laparoscopic live donor nephrectomy into surgical practice in the UK.
Laparoscopic nephrology, or the removal of a kidney from a live donor by a keyhole technique, had removed some of the disincentives to donating a kidney, said Professor Nicholson.
"Patients stay in hospital for a shorter period of time, it's less painful, they can get back to normal activities more quickly, and the cosmetic results are undoubtedly better, particularly for ladies," he said.
"Overall we found the technique has increased live donations by about five-fold in our own centre."
Live kidney transplants were probably the best type of transplantation. There were no waiting lists, the kidneys were in pristine condition when transplanted and gave the best patient's survival figures. The average life of a cadaver transplanted kidney was around eight years, compared to around 15 years for a living related kidney.
Living related transplants were slowly on the increase in this country, now accounting for 20 per cent of transplants. In Leicester in the last six months 60 per cent of transplants were from live donors. Norway had a total of 50 per cent and America 35 per cent.
"The downside of live donation is that is a massive operation to remove a kidney," said Professor Nicholson.
"When you do a kidney removal it has to come out in perfect condition without being damaged, and because of this it is relatively challenging surgery."
The traditional way to do it was to make a big incision in the loin, leading to post operative pain and prolonged recovery from the operation. Laparoscopic surgery was performed through three keyhole incisions, each about a centimetre and half, through which long instruments were inserted and a camera. The surgeon performed the operation looking at a television screen, rather like playing a computer game. Pain control was substantially less after a laparoscopic removal than with the traditional method, recovery time was halved, and there were very few complications. There was no difference in the treatable rejection rates, which were in the region of 30 per cent with both operations.
Looking to the future, Professor Nicholson mentioned a £1m robot which could carry out the operation from anywhere in the country. More realistically, the Leicester unit was looking at a new technique of removing kidneys through relatively small incisions, called minimal incision open operation, to see if it compared favourably with the keyhole technique which took a long time and was very difficult.
Please note, this page is a summary of the full conference speech (click here for the full transcript).
Jane
Verity - Modernising Renal Services
This website is intended for UK residents only.