An innovative kidney removal procedure has been performed at MUSC's Medical Center. The procedure (laparoscopic live donor nephrectomy) holds promise of greatly increasing the number of kidneys donated for transplant by reducing pain and recovery time for the donor.

It is the first time in South Carolina that a kidney has been removed from a donor through laparoscopic surgery, a procedure resulting in less discomfort, no sutures or staples, a shorter hospital stay and much faster recovery period than the traditional surgical procedure to remove a kidney. There are only three centers in the Southeast that perform the procedure.

The successful surgery was performed Sept. 1 on 37-year old Frank McDonald, a Spartanburg Marine currently stationed in Cherry Point, N.C. McDonald’s organ was subsequently transplanted into his sister, 39-year-old Margaret Simpson of Spartanburg, by P.R. Rajagopalan, M.D., head of Transplant Surgery at MUSC.

Kenneth Chavin, M.D., Ph.D., the MUSC surgeon who performed the laparoscopic kidney removal, was assisted during the procedure by Lloyd E. Ratner, M.D., director of renal transplantation at Johns Hopkins Hospital. Ratner is the pioneer in this field, having performed the first procedure with Dr. Louis Kavoussi in 1995. He directs a course at Johns Hopkins University to teach the procedure to practicing surgeons.

Simpson suffered from kidney disease since 1984, but her condition had deteriorated to such an extent within the last six months that she required dialysis. However, she suffered adverse reactions to the dialysis and receiving a kidney transplant became critical. Her brother, as well as numerous family members, including her 16-year-old son, all volunteered to become donors. Tests showed that McDonald’s blood type and other factors matched his sister’s, indicating that a transplant would very likely be successful.

“Donation from a live human donor offers advantages over a cadaver donation,” said Chavin. Currently, in South Carolina there are 405 patients on a waiting list for a cadaver organ. The typical patient waits three to five years. These patients are dependent on dialysis until an organ becomes available In addition, kidneys from a living donor have a better long-term survival rate than kidneys from a cadaver donor.

But, the traditional surgery to remove a kidney from a healthy, living donor has meant a major surgical procedure, with a 10-inch incision that cuts through abdominal muscles. There is a three- to five-day hospitalization following surgery and then a six-week to three-month convalescent period.

A much less invasive surgical procedure, the laparoscopic technique requires that the donor spend only two to three days in the hospital. The majority of donors can return to normal activities within two to three weeks.

The laparoscopic procedure involves making dime-size holes in the abdomen. A TV camera attached to a robotic arm is placed in one of the incisions This transmits an image to a TV monitor, allowing the physician to see what he is doing. The physician can manipulate the camera by voice commands, enabling him to keep the operating field in full view on the monitor. The instruments are placed through the other incisions. The surgeon manipulates these instruments using controls that can be loosely compared to controls on a video game. He cuts the organ from the surrounding structure and then ligates the blood vessels to the kidney. One of the incisions is enlarged to a hole a little larger than a silver dollar, enabling the kidney to be removed.

The availability of this procedure has in other institutions increased live donations by about 40 percent.