Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Abstract

Background and Objectives: Laparoscopic surgery has rapidly expanded in surgical practice with well-accepted benefits of minimal incision, less analgesia, better cosmetics, and quick recovery. The surgical technique for kidney transplantation has remained unchanged since the first successful kidney transplant in the 1950s. Over the past decade, there were only a few case reports of kidney transplantation by laparoscopic or robotic surgery. Therefore, the aim of this study is to develop a laparoscopic technique for kidney transplantation at the region of the native kidney.Methods: After initial development of the laparoscopic technique for kidney transplant in cadaveric pigs, 5 live pigs (Sus scrofa, weighing 45-50 kg) underwent laparoscopic kidney transplant under general anesthesia. First, laparoscopic donor nephrectomy was performed, and then the kidney was perfused and preserved with cold Ross solution. The orthotopic auto-transplant was subsequently performed using the laparoscopic technique. The blood flow of the kidney graft was assessed using Doppler ultrasonography, and urine output was monitored. Results:The laparoscopic kidney transplant was successful in 4 live pigs. Immediate urine output was observed in 3 pigs. The blood flow in the kidney was adequate, as determined using Doppler ultrasonography. Conclusion:It has been shown that laparoscopic kidney orthotopic transplant is feasible and safe in the pig model. Immediate kidney graft function can be achieved. A further study will be considered to identify the potential surgical morbidity and mortality after recovery in a pig model before translating the technique to clinical human kidney transplantation.

A Human Cadaver Model For Laparoscopic Kidney Transplant

“…A large animal model previously was established to facilitate the training of surgeons to perform human laparoscopic kidney transplant. 15 The surgical time for laparoscopic kidney transplant may be longer initially than open 23 The ureteroneocystostomy was done laparoscopically using the same technique as the Lich Gregoir method. surgery but may be shorter in the future after the technique is improved.…”

“…A live animal (pig) model of laparoscopic kidney transplant has been described with orthotopic autotransplant. 15 In the pig model, the renal artery is anastomosed to the stump of the renal artery, the renal vein is anastomosed to the end of the renal vein stump, and the ureter is anastomosed to the ureter in an end-to-end fashion. Although the porcine renal artery is small (diameter, 2 to 3 mm), the frequency of successful vessel anastomosis is 70%, and a reliable and safe vessel anastomosis was confirmed with a laparotomy at the end of the study.…”

Laparoscopic Kidney Transplant by Extra Peritoneal Approach: The Safe Transition From Laboratory to the Clinic

“…First, the surgical technique was established on a large animal pig model. It was demonstrated that laparoscopic kidney transplant was feasible and safe and that immediate renal function can be achieved (8)(9)(10). Following the experiment, a human cavader model was established for laparoscopic kidney transplant by using extra-peritoneal approach (11).…”

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“…In their study of laparoscopic orthotopic kidney transplant, Be and associates used a similar method through a 5-mm trocar. 10 However, Modi and associates did not maintain cold ischemia. Recently, a study following the IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) model for the assessment of new surgical procedures was published in which robotic kidney transplant with regional hypothermia was studied.…”