Right Vs. Left Kidney and surgery set.

[lisamgoldberg]

Hi Again,
So my surgery is set now for December 15th. My renal scan came back showing that my Left bigger kidney has 55% functioning and my R Kidney has 44.5% functioning.
The doctor still wants to remove my Left kidney since it is only 10% difference and small.

Should I feel okay with this? Should I demand to have my R kidney removed? What are the risks of having my right kidney removed?

Does the functionality of my right kidney go up after removal of my left?

Statistically is it better for patients to have the bigger kidney than the smaller one?

What are the risks surgically of removing the R one as opposed to the left one?


Please advise.
Thanks,
Lisa

[john78259]

The left kidney is more accessible than the right. As I understand it, to access the right kidney, there sometimes is a need to remove part of the rib. The surgery for the left kidney is less invasive. Before my donation, I was told that the remaning kidney will actually grow to compensate for doing all the work. The surgeons won't put you at risk. With all the testing they do, they will make sure you have everything to live a healthy life. If there is any kind of doubt, they wouldn't remove anything.

I hope this helps!

[lisamgoldberg]

Thanks so much for your response. I will talk to my doctor to see what he thinks.
Lisa

[WilliamLFreeman]

Lisa,

Both the left and right kidneys can removed by laparoscopic procedure; no rib is removed in either case.  However, occasionally, there is a complication during laparoscopy that requires the surgeon to convert it to an "open" procedure, that is, to directly see and access the entire kidney.  In that case, often part of the rib overlaying the kidney from the back is removed.  (That complication can be bleeding that is uncontrolled, for instance.  That complication can, and rarely does, happen with either a left or right kidney being removed by laparoscopic procedure.)

The usual reasons that the left is preferred to take out are that the renal artery is usually longer to the left kidney than to the right, and that the left kidney may be a bit easier to access by laparoscopy.

As I wrote earlier, my surgeon told me that he always takes the kidney that has lower function, leaving the better kidney for the donor.  I do not know the amount of difference beyond which he would switch to take the right.  Not 49%-51% -- that difference of function is too small to worry about.  Almost certainly 40%-60%. -- too big a difference.  45%-55%?  I do not know.  [I do know that he was prepared to take my right if that was the better kidney.]

Many surgeons are more comfortable removing the person's left kidney than right, because they do it more frequently.  Also, it may be that the anatomy of your left kidney may be more favorable than the anatomy of your right -- e.g., right renal artery very short, single vs. 2- or 3- blood vessels, etc.

Lisa, this is the time to "talk turkey" [  ] with the surgeon, and she/he with you.  The relative size of your kidneys is less important than their relative function.  A 45%-55% difference is not huge, but is it "insignificant"?   True, your remaining kidney will grow larger and the function will increase -- to about 65% to 70% of previous.  But BOTH kidneys will increase their function.  (Assume an increase of 140% of either kidney above her baseline, to achieve total kidney function with ONE kidney that is 70% of what 2 kidneys. provided  If the remaining kidney is now functioning at 45% of total, the actual increase would be to about 60-65% of previous total kidney function -- while for a remaining kidney now functioning at 55% of total, the actual increase would be to about 75-80%.  [The math is 45% X 140& vs 55% X 140%.]

You can -- I think should -- insist on a full explanation and discussion that is satisfactory for you, to include if another surgeon is available with perhaps more experience with right kidney nephrectomy by lapascopic procedure.  (I am NOT suggesting opposition to removing your left kidney -- rather, simply that you should understand and agree with the reason to do so before accepting it and not preferring an alternative.)

I know you want to donate your kidney, and also keep your own health.     ALL THE BEST!!

Bill

[WilliamLFreeman]

Lisa - CORRECTION:

Jatopa informed me that, actually, the right renal artery is longer than the left.  [She does know human anatomy better than I!]  So, I made a consultation with my library.

Both the 2 surgical textbooks I have on living organ donation state that right nephrectomy is a bit more difficult technically for the surgeon primarily because the right renal vein is shorter.  DUH!  Aren't physicians supposed to remember the difference between artery & vein??   

(Also, in order to get to the right kidney laparoscopically, retracting the anterior lobe of the liver requires a bit more effort and technique.  Also, the right renal artery goes behind the vena cava -- the huge vein that collects all venous blood from the legs & pelvis and brings the blood to the heart -- and thus requires more work and technique to free up.)

However, each donor's internal anatomy may differ from the "usual," so the particular circumstances for any donor may lead the surgeon to want to take one or the other kidney.  So, please discuss your concerns with the surgeon your options and situation until you are satisfied.

(And, Thank you, Jatopa.)

Bill

[lisamgoldberg]

Wow, lot's of information. I will talk with my surgeon next week.
Thanks.
You all are great!