“I would say the LESS procedure, laparoendoscopic single-site surgery, will make a difference this year. We are working toward that for donor nephrectomies, which we do a lot of for transplants.
It makes a couple of differences. About 12-15 years ago, we saw a significant uptick in the number of living donor transplants when we started doing laparoscopic donor nephrectomies. That’s plateaued, but is still significantly higher than 20-25 years ago. We hope single-site surgery will increase people’s willingness to come forward, because it’s even less invasive. Also, our donors usually go home on post-op day two, but patients may be able to get out the day after their surgery.
We’re also working on a new MRI technique. Because most of our patients have renal insufficiency, they can’t get a contrast CT or MRI if they’re facing a kidney transplant because of renal failure. Ironically, once kidneys fail and patients are on dialysis, they can have a contrast CT because their kidneys are already dead. But for patients still limping along with poor kidney function, not on dialysis, if they have something suspicious in the kidney, it’s hard to work up. So we’re using a new technique using ferriheme, a new contrast material to help us see the anatomy of the kidneys, as well as blood vessels, providing a helpful roadmap for us. We’ll probably be using it in 2018.
With anesthesiologists, we developed new pathways of doing donor nephrectomies without narcotics after surgery. We’re using regional anesthesia, putting in muscular blocks to block pain receptors in the surgical area, providing localized pain relief rather than systemic relief with narcotics. We hope to make it more palatable for donors so they don’t deal with the constipation, nausea, etc.”
Christian Kuhr, MD