Surgical innovation eases kidney transplants Technique pioneered at Baltimore hospitals being adopted nationwide

October 18, 1997|By CHICAGO TRIBUNE

CHICAGO -- At 56 years old, Luis Esparza Sr. feels like a "new man," and for that he thanks Luis Esparza Jr. and the four tiny incisions his son now sports on his abdomen as well as a 3-inch cut near his belly button.

Through the smaller holes, doctors slipped a tiny camera and surgical tools. They then slipped one of the younger Esparza's kidneys, drained of blood, through the larger hole. The organ was then transplanted into his ailing father.

This relatively new and less traumatic procedure for taking kidneys from a living donor was tried at Northwestern Memorial Hospital in Chicago last week for the first time.

It is most commonly practiced at the University of Maryland Medical Center and the Johns Hopkins Hospital in Baltimore.

Officials at both institutions say they are pleased with the outcomes.

At the University of Maryland hospital, where 141 such operations have been performed since March 1996, the procedure is now considered standard practice.

On Wednesday, a week after the Chicago surgery, both Esparzas were up, around and smiling on the completion of a procedure that is expected to move from experimental to commonplace in the coming years.

"I feel like a new man, like I was born again, that's how good I feel thanks to my son," said the elder Esparza.

"It's something I wanted to do for my father," said the 24-year-old, the youngest of five children. "I saw the pain that he went through, and there was something I could do. I am single, had no strings attached and felt strong enough and healthy enough to go through the procedure."

Because the body has two kidneys and can function with just one of them, living people have long been used as donors. But conventional surgery to remove a healthy kidney from a living donor can be traumatic.

Usually, a 6- to 8-inch incision is made and the ribs are spread, and sometimes a piece of rib is removed. It can take more than a month for a donor to heal well enough to return to work. The new laparoscopic procedure, which is less invasive, typically allows patients a shorter hospital stay, speeds recovery by several weeks and is less traumatic.

"Recovery is faster and less pain is associated with the recovery period," said Dr. Joseph Leventhal, a transplant surgeon at Northwestern who led the program's development there.

Laparoscopic techniques have been used since the 1970s.

But the approach really took off in the 1980s, when it was used in gall bladder surgery. Several years ago, a handful of surgeons began trying it on living kidney donors.

Maryland surgeons report that donors are more willing to give organs and that people with kidney failure are more willing to allow loved ones to consider donation if laparoscopic techniques are used.

"In the past, many potential recipients would say, 'I don't want to trouble my family,' " said Dr. Stephen Bartlett, head of the division of transplantation at the Maryland hospital. "Now, we're able to show them this technology and the ease with which people can donate a kidney, and [the recipient's] reluctance diminishes markedly."

But some surgeons have expressed concerns about whether the procedure may more easily damage the donor organ. Even Bartlett and others enthusiastic about the new technique urge caution.

To avoid having inexperienced surgeons attempt the technique, both the University of Maryland and Johns Hopkins are offering training to interested surgeons. Teams from medical centers in most states and several foreign countries have undergone training.

But even some experienced laparoscopic surgeons are not eager to try it on living kidney donors.

"You want to look at better ways of doing things, but the risks are significant," said Dr. David Albala, associate professor of urology at Loyola University Medical Center in Maywood.

He also expressed skepticism that the new technique would significantly increase the number of organs available for transplant.

"There is no question that people heal faster and recovery times are better, but I am not sure that will increase the donor pool of kidneys given," he said.

Indeed, Luis Esparza Jr. said he would have given his father a kidney even if he had to undergo the conventional procedure: "He needed the kidney, and I wanted to give it to him so he could live his life."

Pub Date: 10/18/97

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