Transplant Procedure

Following the induction of general anaesthesia, catheter is inserted. It is connected to an antibiotic containing saline solution. A hockey stick incision is made in the lower quadrant of the abdomen. The right side is usually used for a first transplant as the iliac vein is more superficial. To expose the iliac vessels the inferior epigastric vessels are divided, the peritoneum is swept medially, and the spermatic cord is mobilised (in females, the round ligament is divided). An Omnitract is positioned to maintain exposure. The renal vein or the caval extension is anastomosed to external iliac vein, in an end to side fashion. All the lymphatics are ligated with suitable suture material to prevent lymphocele. The donor renal artery or, in the case of cadaveric kidney, the Carrel patch is anastomosed to the external iliac artery in an end to side fashion, using an aortic punch to create an arteriotomy.7 After the vascular connection is complete, the vascular clamps are released. If necessary, additional sutures are placed to obtain haemostasis. This is not likely to be required, however, if meticulous suturing is done using optical loops. Next, the kidney is positioned in the retroperitoneum to avoid kinking of the vessels, and the ureter is anastomosed to bladder in a meticulous way so that haematuria does not occur. Haematuria can be a major problem and require blood transfusion.

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