Bulang He

Laparoscopic surgery for orthotopic kidney transplant in the pig model.

BACKGROUND Laparoscopic surgery has become the preferred approach in surgical practice due to multiple benefits. Over the last decade, kidney transplant by laparoscopic or robotic techniques have been explored. The aim of this study is to establish a new laparoscopic technique for kidney orthotopic transplant. MATERIALS AND METHODS The study was approved by the Animal Ethics Committee of the University. Ten live female pigs (Sus scrofa), weighing 45-50 kg, underwent laparoscopic kidney orthotopic transplant on left side under general anesthesia, and the opposite right kidney was defunctioned by complete ligation of the ureter at the same time. RESULTS The vital signs of all pigs were stable during the surgery and postoperative period. There were no intraoperative complications and no conversion to open surgery. The laparoscopic kidney transplant was successful in seven of 10 pigs. Seven pigs were observed up to 4 wk as planned in the study. DISCUSSION To our knowledge, this is the first study of laparoscopic kidney orthotopic transplant in pig model with satisfactory immediate graft function. It was demonstrated that laparoscopic kidney transplant is a feasible, reliable, and safe procedure. However, it is a very demanding technique. Adequate training is mandatory for performing laparoscopic kidney transplant. This study could be used as a training model for surgeons who wish to perform human laparoscopic kidney transplant in the future.

Laparoscopic surgery for kidney orthotopic transplant in the pig model

The authors report that a laparoscopic technique could facilitate orthotopic kidney transplantation in selected patients.

Laparoscopic kidney transplant by extra peritoneal approach: The safe transition from laboratory to the clinic

The aim of this study is to develop a novel laparoscopic surgery by extra‐peritoneal approach for kidney transplant and pave the way of safe transition from laboratory to the clinic. The study was established to explore the feasibility and safety of human laparoscopic kidney transplant. The experiment was first conducted on the deceased animals, then live animals and human cavader before human kidney transplant was approved. The study patient was a 49‐year‐old male who received the kidney for laparoscopic kidney transplant by extra‐peritoneal approach. The control patient received the contralateral kidney for open kidney transplant. The estimated blood loss was minimal during surgery. Both kidneys experienced delayed graft function but the kidneys started function on Day 6 postoperation. The analgesia consumption was significantly less in the study patient. There is no surgical complication during 6‐month follow‐up. This study has developed a new technique for laparoscopic kidney transplant by extra‐peritoneal approach. It has retained the advantages of open kidney transplant, which allows the graft located in the extra‐peritoneal space without violating peritoneum. This study has also paved the way of safe transition for a novel laparoscopic surgery from laboratory to the clinic.

Laparoscopic Kidney Orthotopic Transplant: Preclinical Study in the Pig Model

BACKGROUND Laparoscopic surgery has rapidly expanded in clinical practice replacing conventional open surgery over the last three decades. Laparoscopic donor nephrectomy has been favored due to its multiple benefits. The aim of this study was to explore the safety and feasibility of kidney transplantation by a laparoscopic technique in a pig model. MATERIALS AND METHODS The study was approved by the university animal ethics committee. Eight female pigs (Sus Scrofra, weighing 45-50 kg) were divided into 2 groups: group I included 4 animals that underwent laparoscopic kidney orthotopic transplantation on the left side. The right kidney was remained functional in situ. The pigs recovered and were observed for 1 week. In the 4 hosts group II pigs underwent a laparoscopic kidney transplantation on the left side. With simultaneous clipping of the right ureter. After recovery, the pigs were observed for 4 weeks. A laparotomy for examination was performed prior to euthanasia. RESULTS All 4 group I pigs survived for 1 week. The laparotomy showed normal graft perfusion with wall patent renal artery and vein as well as satisfactory urine output upon transection of ureter in 3 hosts. Renal artery stenosis occurred in one pig. In The Immediate kidney graft function was achieved in 3 group II pigs. The fourth died following extubation due to laryngospasm despite a functional graft. The average creatinine levels were 195.5 μmol/L on day 3; 224.5 μmol/L at week 1; 127 μmol/L at week 2; 182.7 umol/L at week 3; and 154.7 umol/L at week 4. CONCLUSION Laparoscopic kidney transplantation was feasible and safe in a pig model with immediate graft function. This study will provide further evidence to support application of laparoscopic technique to human kidney transplant.

Catheterization of the urethra in female pigs.

Female pigs are commonly utilized as an animal model for biomedical research and require urethral catheterization. Sixteen pigs were anaesthetized for research purposes and required the placement of a urethral catheter. Post-mortem examination of the vaginas revealed the urethral opening to be consistently halfway from the mucocutaneous junction of the vulva to the cervix. A shallow diverticulum was also observed on the ventral floor of the urethral opening. To optimize conditions for success the pig should be carefully positioned supine, a vaginal speculum and light source should be used, the pig should be adequately anaesthetized, and the anatomy of the vagina should be reviewed.

Clinical importance of anatomical variations of renal vasculature during laparoscopic donor nephrectomy

Abstract Introduction Laparoscopic live donor nephrectomy has become a well-accepted practice in most transplant units. However, the variations and complex of renal vasculature may make the surgery even more challenging during laparoscopic donor nephrectomy. The aims of this article are to review embryology of the renal vasculature development and the clinical significance of renal vasculature anomalies during laparoscopic donor nephrectomy and the consequence of kidney transplant. Discussion The results were interpreted and summarised as renal artery development and its anomalies and renal vein development and its anomalies including associated anomalies of the inferior vena cava. The clinical significance during laparoscopic donor nephrectomy was explored. The value of computed tomography angiography was emphasised during live donor work-up and before surgery planning. Conclusion It is paramount for surgeons to have a thorough knowledge of renal vasculature development and to readily identify the anomalies of renal vasculature on computed tomography angiography prior to laparoscopic donor nephrectomy. The adverse Clinical importance of anatomical variations of renal vasculature during laparoscopic donor nephrectomy

Establishment of laparoscopic live donor nephrectomy in a porcine model: techniques and outcomes in 44 pigs

BACKGROUND Laparoscopic live donor nephrectomy has replaced open donor nephrectomy in most patients due to numerous benefits. A live animal model is required to equip surgeons with the necessary skills to perform such a procedure with minimal risk of complications. The aim of this study was to establish the technique for laparoscopic live donor nephrectomy in a porcine (Sus scrofa) model. MATERIALS AND METHODS This study was approved by the Animal Ethics Committee of the university. Forty-four pigs underwent laparoscopic live donor nephrectomy. The left kidney was removed with a standardized four-port technique, with a small suprapubic incision to facilitate kidney delivery. RESULTS All 44 procedures were performed successfully, with no intraoperative complications or conversion to open surgery. There was no apparent damage to any of the kidney grafts. The mean surgical time was 118.3 (±20.7) minutes. There was a small, but statistically insignificant, decrease in surgical time throughout the duration of the study. Several subjects had minor variations in the anatomy of the renal vasculature. CONCLUSIONS This series has developed and proven a training model for laparoscopic donor nephrectomy in pigs. This training model will allow surgeons to develop laparoscopic proficiency in a live donor, to be used in conjunction with human cadaveric training.

Preventable Urological Complications Post Kidney Transplant with Modified Lich-Gregoir Technique for Ureteroneocystostomy

Aim: Various ureteroneocystostomy techniques for kidney transplant have been described with Lich-Gregoir (LG) being widely employed. However, even with multiple modifications on this technique, urine leakage and ureteric stenosis remain as most common complications. This study aims to evaluate urological complications by using our modified LG technique after kidney transplant. Method: From 26th January 2010 to 30th May 2014, 206 consecutive kidney transplants were performed at our institute. 124 were deceased-donor and 69 were live-donor kidney transplants; 13 patients received a small tumour excised kidney graft. All transplants except one were done by conventional open surgery. The modification involves an additional stitch placed at proximal part of bladder muscular incision with peri ureteric tissue at the entrance of ureter to bladder. Urological complications were defined as urine leakage or ureteral stricture. The patients were followed-up from 12 to 64 months. Results: There was no urine leakage in this cohort. One case of ipsilateral dual-kidney transplant developed distal ureteral stricture secondary to a lymphocele that was treated by laparoscopic fenestration. Subsequently, surgical reconstruction of urinary tract was required and success. Seven cases had mild to moderate hydronephrosis identified on CDU; 4 were due to a lymphocele; 3 were secondary to urinary tract stones. Four patients had renal pelvis prominence on CDU, which was spontaneously resolved with satisfactory renal function. Conclusion: From this study, it is demonstrated that urine leakage can be prevented and ureteric stricture may be minimised by using this modified LG technique. The ureter was always shortened in an adequate length and a ureteric stent was inserted. This modification is simple and reproducible by placing additional two stitches, which secure the potential gap at the entrance of ureter to the bladder.

Update on laparoscopic/robotic kidney transplant: A literature review

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Transplant Research and Risk Management 2013:5 33–39 Transplant Research and Risk Management Dovepress

Transition from Laparoscopy to Retroperitoneoscopy for Live Donor Nephrectomy - A Case Control Study

Introduction Laparoscopic donor nephrectomy has become the standard of care due to multiple benefits. Transperitoneal laparoscopic (TLDN) approach is currently being widely adopted in most transplant centres. However, a systematic review has shown that an alternative retroperitoneoscopic (RLDN) approach is associated with fewer complications due to the anatomical advantage by avoidance of manipulation of the intraperitoneal organs. There was limited data available in assessing the learning curve for transition to RLDN. The aims of this study were to compare the outcomes of RLDN and TLDN by a case control study. The learning curve for transition from TLDN to RLDN was analyzed. Materials and Methods From Dec 2012, the authors have changed the surgical technique for live donor nephrectomy from TLDN to RLDN after a mentorship. Sixty two cases of live donor nephrectomy have been performed by RLDN up to Oct 2017. For an efficient analysis, another 60 cases of live donor nephrectomy by TLDN were included retrospectively in this study. Data on patient demographics, peri-operative parameters, analgesia consumption, pain scores and kidney graft function were collected and analyzed. Statistical analyses were performed with a student’s t-test or Mann-Whitney test. A CUSUM analysis was also performed to explore the learning curve by setting the mean operative goal time of TLDN as a target. Results All these 122 donor nephrectomies were successful with no conversion to open surgery. There was no blood transfusion, readmission or mortality. There were no post-operative complications which were graded over Clavien II. The kidney graft function was comparable in both groups. The follow-up period ranged from 2 to 86 months. The CUSUM analysis demonstrated that approximately 30 cases are required for the surgeon to be proficient in the transition from TLDN to RLDN. Conclusion RLDN is a safe approach with comparable results to TLDN. It has an anatomical advantage as it avoids manipulating the intraperitoneal organs and retains a virgin abdomen and hence translates to a lower peri-operative complication risk. The learning curve of transitioning from TLDN to RLDN of about 30 cases is acceptable.