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Laparoscopic Live Donor Nephrectomy Pre- and Postoperative Instructions

Prior to Surgery

What to Expect during Your Preoperative Consultation

All potential donors undergo extensive medical and psychological evaluation ensuring that the donor will maintain normal kidney function following surgical removal of the kidney intended for donation. The following tests are necessary prior to donating your kidney:

  • Blood work: There are several routine blood tests to assess your blood count, blood type, kidney function and general health. Tissue typing is also done through a blood test to assess the degree of genetic similarity between the donor and the recipient. Your blood will also be tested for many other diseases, including hepatitis and HIV.
  • Other routine testing includes: Electrocardiogram (EKG), chest X-ray, urinalysis, a stool test that can be done at home to check for blood in your stool and a 24-hour urine collection.
  • 3-D computed tomography (CT) scan of the abdomen and pelvis: This is a sophisticated three-dimensional X-ray, which provides anatomical detail of the size and shape and blood vessels of the kidneys. All kidney donor candidates undergo a 3-D CT scan to determine which kidney is the most suitable for donation.
  • Female patients need a gynecological exam and a pregnancy test. A mammogram is necessary for women older than 39.
  • Male patients older than 39 need to have a blood test called a prostate-specific antigen (PSA) test to check for prostate problems including prostatitis, prostate cancer and enlarged prostate.
  • A psychological evaluation is done to ensure that the donor has a full understanding of his or her role in the transplant process.
  • Final cross match: This is done through a blood test. You, along with the recipient, will have to have your blood tested within one week of the transplant to ensure compatibility. If for any reason this test comes back positive, the surgery will have to be cancelled. There may be other options that the transplant team will discuss with you.

Preparation for Surgery

Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)

Bowel preparation and clear liquid diet
Drink one bottle of magnesium citrate, which you can purchase at your local pharmacy, the evening before your surgery. Do not eat or drink anything after midnight.

Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.

Clear liquid diet
Remember not to eat or drink anything after midnight the evening before your surgery.
Clear liquids are liquids that you are able to see through. Please follow the diet below.

  • Water
  • Clear broths (no cream soups, meat, noodles, etc.)
    • Chicken broth 
    • Beef broth 
  • Juices (no orange juice or tomato juice)
    • Apple juice or apple cider 
    • Grape juice 
    • Cranberry juice 
    • Tang 
    • Hawaiian punch 
    • Lemonade 
    • Kool-Aid 
    • Gatorade
  • Tea (you may add sweetener but no cream or milk)
  • Coffee (you may add sweetener but no cream or milk)
  • Clear Jell-O (without fruit)
  • Popsicles (without fruit or cream)
  • Italian ices or snowballs (not marshmallow)

What to Expect after Surgery

During Your Hospitalization

Immediately after the surgery you will be taken to the recovery room and transferred to your hospital room once you are fully awake and your vital signs are stable.

  • Postoperative pain: Pain medication can be controlled and delivered by the patient via an epidural, an intravenous catheter or by an injection (pain shot) administered by the nursing staff. Once on a regular diet, pain medications may be taken by mouth instead of by IV or shots. You may experience some minor shoulder pain (one to two days) related to the gas used to inflate your belly during the laparoscopic surgery. Transient testicular pain can occur but is uncommon.
  • Nausea: You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea. 
  • Urinary catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while you are asleep) for approximately one day after your surgery. It is not uncommon to have blood-tinged urine for a few days after surgery.
  • Intravenous catheter: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube fed into your vein so that you can receive necessary fluids and stay well hydrated; it also provides a way to receive medications.)
  • Fatigue: Fatigue is common and should start to subside in a few weeks.
  • Prevention of blood clots: You can expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to prevent blood clots from forming in your legs.
  • Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help to prevent pneumonia and other pulmonary complications.
  • Walking: On the first day after surgery it is very important to get out of bed and begin walking with the supervision of your nurse or a family member to help prevent blood clots from forming in your legs.
  • Diet: Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day.
  • Length of hospital stay: The length of hospital stay for most patients is approximately two days.
  • Constipation/gas cramps: You may experience sluggish bowels for several days following surgery as a result of the anesthesia. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help to prevent constipation. Narcotic pain medication can also cause constipation, and therefore patients are encouraged to discontinue any narcotic pain medication as soon after surgery as tolerated.

What to Expect after Discharge from the Hospital

  • Bathing: You may shower at home after returning from the hospital. Your wound sites can get wet but must be padded dry immediately after showering. Tub baths are not recommended in the first two weeks after surgery, as this will soak your incisions and increase the risk of infection. You will have adhesive strips across your incisions. They will fall off in approximately five to seven days on their own. Sutures underneath the skin will dissolve in four to six weeks.
  • Activity: Taking walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible but should be taken slowly. Driving should be avoided for at least one to two weeks after surgery. Absolutely no heavy lifting (greater than 20 pounds) or exercising (jogging, swimming, treadmill, biking) for six weeks or until instructed by your doctor. Most patients return to full activity at home on an average of three weeks after surgery. You can expect to return to work in approximately four weeks.
  • Preventive care: You should see your family doctor or primary care physician yearly for a routine check up and for blood tests to determine the function of your remaining kidney. You should take special care of your remaining kidney by avoiding any type of contact sport, which can damage it. You should be on a no-added salt diet and should always avoid high-protein diets.
  • Postoperative visit: You will need to call the office of your surgeon soon after your discharge to schedule a follow-up visit for four weeks after your surgery date.

Our Surgeon

Photo of Dr. Mohamad Ezzeddine Allaf, M.D.

Allaf, Mohamad Ezzeddine, M.D.

Professor of Urology
Associate Professor of Biomedical Engineering
Professor of Oncology
Executive Vice Chairman, Department of Urology
Director of Adult Urology
Director, Minimally Invasive and Robotic Surgery
Expertise, Disease and Conditions: Kidney Cancer, Laparoscopic Kidney Surgery, Prostate Cancer, Robotic Prostatectomy, Urology
 

Appointments

To make an appointment for consultation, please call 410-955-6100.

In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 and ask to speak to the urologist on call.

For appointments with the transplant surgeons, call the Transplant Office at 410-955-5045.

In the event of an emergency and you need to contact someone in the evening hours or on the weekend, please call the paging operator at 410-955-6070 and ask for the transplant coordinator on call.

Directions to The Johns Hopkins Hospital

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