Feasibility of laparoscopic orthotopic kidney transplantation: Initial research with a pig model

Abstract

The objective of this study was to investigate the feasibility of laparoscopic orthotopic kidney transplantation. This study involved bilateral laparoscopic nephrectomy in pigs. One of 2 kidneys harvested from the first or second nephrectomy was chosen as the donor kidney to be transplanted to the left or right side in the second nephrectomy position. Eight laparoscopic orthotopic kidney transplantations were performed. The mean venous anastomotic time was 70 minutes (45-108 minutes). The mean arterial anastomotic time was 31 minutes (23-45 minutes). Three pigs received life-supporting auto-renal allografts. Their serum creatinine levels were 163, 285, and 440 µmol/L (baseline: 133 µmol/L), respectively, at postoperative day 7. One died of a possible anesthetic overdose immediately after the operation. Four pigs died at postoperative days 2, 3, 4, and 4. Of 8 completed laparoscopic orthotopic kidney transplantations, 6 had autopsy-proven reliable artery and vein anastomoses. Histopathologic examination of the autografts demonstrated normal renal architecture in 1 survival, and acute tubular necrosis in the remaining 7 (stenosis in one and arterial thrombus in another). Our study reinforces the feasibility of laparoscopic orthotopic kidney transplantation in pigs. This study comprised only initial practices; further practice is needed to refine the surgical procedures and decrease surgical complications in laparoscopic orthotopic kidney transplantation.