This article details the procedure for complete nephrectomy in a pig model, focusing on the surgical techniques involved in kidney removal. The process includes careful dissection and ligation of renal vessels and ureters to ensure successful graft preparation for transplantation.
Complete nephrectomy involves the ligation of renal blood vessels and ureter, followed by their dissection to remove the entire kidney. To begin, prepare an anesthetized pig in the supine position. Make a midline abdominal incision to expose the abdominal organs. Keeping the intestines warm and hydrated for optimal tissue function, displace them.
Incise the peritoneal tissue layer to reveal the left kidney and its vascular structures. Kidneys - two bean-shaped organs on either side of the abdomen - have narrow tubular structures called ureters that carry urine from the kidney to the bladder.
Dissect the left kidney and its ureter from the surrounding adherent tissue. Ligate and incise the ureter distally from the renal hilum - the site where blood vessels and the ureter enter and exit the kidney. Ligate and dissect the lumbar vein diverging from the dorsal portion of the renal vein to expose the renal vein and aorta.
Clamp the renal artery - a branch of the abdominal aorta - close to the aorta, obstructing blood flow to the kidney. Clamp the renal vein branching off the inferior vena cava close to it. Sever the renal artery and vein close to the clamped regions to excise the kidney. Suture the stumps of the renal artery and vein to minimize blood loss. Close the surgical incision. The excised kidney graft is ready to be processed for transplantation.
Following surgical disinfection, and sterile draping, perform a median laparotomy to open the abdomen, and use a standard abdominal retractor to expose the surgical field. Open the peritoneal layer, and use a monopolar cautery, bipolar forceps, and fine scissors to dissect the left kidney and ureter from any adherent tissue. Then, use a 3-0 polyglactin suture to ligate and divide the left ureter at least 10 centimeters distal to the kidney hilum.
To retrieve the graft kidney, use vascular clamps to close the renal artery and vein, close to the aorta and vena cava, and cut the vessels above the clamps. Then, give the kidney to the back table team for additional preparation, and use a 5-0 polypropylene suture to close the stump of the renal artery and the renal vein.
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