lap or open

[ireysc]

Hi, my name is Sharon.  This is my first time on this forum.  I am slotted to donate my kidney to my son next week on the 18th of Jan.  I'm a lil nervous because this will be my first surgery, but its my son so I have no hesitation to do it.  The surgeon has given me the option of lap or open surgery for the kidney removal.  It's my right kidney so lap would require clamping the livery up and moving the vena cava out of the way.  He says my anatomy is a lil complicated.  Says it would be easier to do open, but then he is pretty sure he can do lap w/o complications as well.  Anyone have an opinion on the matter?  I gotta give him my answer this afternoon.  Any input would be appreciated.

[jatopa]

Hi Sharon,
I'm a little concerned that the surgeon is leaving this decision to you.
Laparoscopic leads to a much easier recovery, but if he is not confident, then perhaps an open would be safer.   
Is there another surgeon at your center who might give a second opinion?   
My consent process was for laparoscopic, with conversion to open if needed. 
Good luck!
Jatopa   

[ireysc]

He is willing to do either.  He is a very good surgeon, we talked for an hour about this decision yesterday.  He says he is pretty sure lap would go fine, but it has more risk for complications.  He has talked with my son's surgeon as well, his surgeon wants it to be open because it's easier to get longer arteries for my son's transplant, but my surgeon wants me to decide what's right for me.  I'm just not sure what the right decision is.

[sherri]

You may want to get a second opinion from another surgeon just like you would if you were having any other type of surgery. This is an elective procedure so there is no rush, just inconvenience for the hospital, but you may feel better discussing this with another experienced surgeon just to get another medical opinion. There is a list of questions on this forum somewhere, maybe someone else can help locate, written by Bill Freeman a physician/donor, of questions to ask your surgeon. You also need to know how many laps this surgeon has done, how many open surgeries (since there have been so many more laps has he had recent experience doing the open), the recuperation time for both, open more invasive than lap but since your anatomy is difficult you need to have statistics for your particular case and not just in general. Sometimes some laps turn into open surgeries if a complication arises so it certainly isn't unheard. Sounds like you could use more information before making this decision.
Where are you donating? maybe someone else here can contribute if they have had the same surgeon.


Good luck and keep us posted.

Sherri

[Fr Pat]

     When I donated 10 years ago my surgeon said he preferred the open method because he considered it safer for the donor. He explained that IF something went wrong during the surgery (e.g. bleeding problems) the blood would "blind" the scope in laporoscopic surgery and require a quick change to open method. He preferred being able to directly see (and correct immediately) any problems. He said that likewise he prefered to see directly the entire area before closing up, to try to spot any problems. I did not know much either way at the time, so I willingly went along with that, and all went very well. There were some painful times during healing, due to the 8-10 inch incision, but I left the hospital on the 3rd day needing only tylenol.
     From what I have read, there is a SLIGHTLY higher risk of complications in the laporoscopic method. BUT in the laporoscopic method there is a BIG difference in the rate of complications depending on how many laporoscopic surgeries that doctor has done, as there is a definite "learning curve" involved in mastering the use of remote-control instruments.
      Things have changed in 10 years, of course, but I would suggest that you tend to opt for the method that seems to be SAFER for you, and put recovery time and recovery pain in second place. Perhaps you might have asked the surgeon which method HE would choose if he himself or a family member were the donor?
      Best wishes. Please let us know how things go.
      If you haven't seen them already, check the "helpful hints" the National Kidney Foundation collected from past donors:
www.kidney.org/transplantation/livingdonors/infotips.cfm.
         FR. Pat

[ireysc]

Thank you so much for the advice and suggestions.  I did check out the website and it was helpful.  I will be having my surgery at UWMC in Seattle and my son will be having his at Seattle Children's.  My surgeon is pretty well skilled at both open and lap, he's been doing both for years.  He weighed with me the pros and cons of both.  I talked to him some more and my son's two surgeon whom will be doing his transplant.  We will be going with the open surgery, it's safer for me and better outcomes for my son.  So thanks for the advice, I'll let you know how it goes. :)

[sherri]

Sharon,

Best of luck to both you and your son. The physician/donor Bill Freeman I mentioned actually had his surgery at Swedish in or near Seattle. He is a great resource so if you'd like email him from this site. You can see his many posts on the forum section at the top. He is a very active in donor advocacy.

Let us know how everything goes.

Sherri

[jatopa]

I'm glad you have made a decision.   It sounds like you are in good hands.