Nephrectomy in a Porcine Model: A Surgical Procedure to Retrieve Porcine Kidney Graft for Transplantation

Published: April 30, 2023

Abstract

Source: Liu, W. J. et al., Orthotopic Kidney Auto-Transplantation in a Porcine Model Using 24 Hours Organ Preservation and Continuous Telemetry. J. Vis. Exp. (2020)

This video demonstrates nephrectomy, the surgical procedure to remove one of the kidneys along with the section of the ureter. The blood vessels to and from the kidney are tied and divided. The excised kidney can be used for transplantation procedures.

Protocol

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Nephrectomy and kidney graft retrieval

  1. Following surgical disinfection and draping, perform a median laparotomy to open the abdomen (25-30 cm). Use a standard abdominal retractor to expose the surgical field.
  2. Use wet and warm abdominal towels to cover the colon and the small bowel. Ask the second assistant to hold the bowel to the direction of right hemi-abdomen exposing the kidney and its vascular structures.
  3. Open the peritoneal layer and dissect the left kidney and the ureter from any adherent tissue using the monopolar cautery, bipolar forceps, and fine scissors.
  4. Ligate and divide the left ureter (3-0 polyglactin) leaving an at least 10 to 12 cm long segment.
  5. Complete the dissection of the left renal vein(s) and artery to their origin from inferior vena cava and aorta, respectively.
    NOTE: Avoid injury and opening of the large lymphatic vessels in this anatomical region. Also be aware of a potential injury to the azygo-lumbar vein joining to the renal vein near to its origin from the vena cava.
  6. Dissect and ligate the azygo-lumbar vein between two ligatures (3-0 polyglactin).
  7. Prepare for the back-table dissection using a bowl of ice and a sterile cover.
  8. To retrieve the graft kidney, clamp the renal artery and the renal vein close to the aorta and the vena cava with vascular clamps. Remove the kidney graft by cutting the vessels with a scissor close to the clamps then hand the kidney over to the back-table team.
  9. Close the stump of the renal artery using a 5-0 polypropylene suture. Close the renal vein using a two-layer continuous suture with 5-0 polypropylene. Remove the vascular clamps.
  10. After checking the area for bleeding or lymphatic leakage, close the abdomen in 4 layers.
    NOTE: Peritoneum: 3-0 polyglactin running suture; fascia: 0 polyglactin running suture; subcutaneous layer: 3-0 polyglactin running suture; skin: skin staplers after kidney retrieval surgery, to facilitate re-opening the abdomen the following day and 2-0 polypropylene single knot sutures after the transplantation procedure for definitive closure.

Declarações

The authors have nothing to disclose.

Materials

Gosset abdomenal wall spreader CHIRU-INSTRUMENTE, Kaierstuhl,Germany 09-621512 Abdominal retractor
Prolene 2-0, blue monofil VISI-BLACK, FS needle Johnson & Johnson Medical GmbH – Ethicon Deutschland, Norderstedt, Germany EH7038H Skin
Prolene 3-0,blue monofil,FS1 needle Johnson & Johnson Medical GmbH – Ethicon Deutschland, Norderstedt, Germany EH7694H Skin
Prolene 5-0 (simply angulated, C1 needle) blue monofil VISI-BLACK Johnson & Johnson Medical GmbH – Ethicon Deutschland, Norderstedt, Germany EH7227H Vascular
Prolene 5-0 (double armed, C1 needle) 60cm Johnson & Johnson Medical GmbH – Ethicon Deutschland, Norderstedt, Germany KBB5661H Vascular
Buprenorphine (Buprenovet) Bayer Vital AG, Leverkusen, Germany 794-996 Analgesia
Sempermed derma PF Surgical Gloves Seril Gr. 7, 7.5, 8  Semperit investment Asia Pte Ltd, Singapore 42,00,78,24,20,08,71,40,00,000 Surgical gloves
Sentinex® PRO Surgical Gowns Spunlace XL 150cm Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany 19302 Surgical gown
Telasorp Belly wipes (green 45x45cm) PAUL HARTMANN AG,Heidenheim, Germany 4542437 Abdominal towel
DE BAKEY-SATINSKY vascular clamp 215mm ASANUS Medizintechnik GmbH, Tuttlingen, Germany  GF1661 Vascular clamp
Dissecting scissors Mayo,250 mm, 10" ASANUS Medizintechnik GmbH, Tuttlingen, Germany  SC2232 Scissors for dissection
Dissecting scissors Metzenbaum-Fino, 260 mm, 101/4" ASANUS Medizintechnik GmbH, Tuttlingen, Germany  SC2290 Scissors for dissection
Bipolar forceps 16 cm straight, Branch 0,30 mm pointed, universal fit Bühler Instrumente Medizintechnik GmbH,Tuttlingen, Germany 08/0016-A Biopolar forceps
surgical scissors standard pointed-blunt (thread/cloth scissors)175 mm, 7" ASANUS Medizintechnik GmbH, Tuttlingen, Germany  SC1522 Surgical Scissors
Titanit vascular scissors POTTS-SMITH,185 mm, 71/4"60° ASANUS Medizintechnik GmbH, Tuttlingen, Germany  SC8562 Pott scissors
HF surgical device ICC 300, Electrocautery Erbe Elektromedizin Gmbh; Tübingen, Germany 20132-043 Cautery, biopolar

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Nephrectomy in a Porcine Model: A Surgical Procedure to Retrieve Porcine Kidney Graft for Transplantation. J. Vis. Exp. (Pending Publication), e20912, doi: (2023).

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