Deceased Donor Renal Transplantation Operative Sample
DESCRIPTION OF OPERATION: The patient was intubated under general endotracheal anesthesia. A central line was inserted for central venous pressure monitoring in the right internal jugular vein. Bladder irrigating solution was also instilled.
The kidney was on a perfusate pump; it was removed. It was a right kidney and we cleaned off Gerota fascia and the right adrenal gland. We separated the artery from the vein. The vena cava was on hold. We oversewed and ligated the upper portion of the cava and tributary lumbar branches were sutured. We used the lower portion of the cuff and swung that over to be a part of our extension graft for the vena cava. The artery and vein were separated. Tributary branches were ligated. A single ureter was cleaned off. We cut the Carrel patch from the aorta for the renal artery from the right side. Kidney was left on ice. Was given 500 mg of Solu-Medrol for infection therapy and 150 mg of IV Thymoglobulin was run over 6 hours.
A curvilinear incision in his right groin was made, one fingerbreadth above the pubis symphysis, two fingerbreadths medial to the anterior-superior iliac spine to the level of the umbilicus. We dissected through subcutaneous tissue and external oblique. We encircled the cord structures and inferior epigastric vessels were retracted medially.
Once we entered through the external oblique, we entered retroperitoneum through the transverse abdominis muscle. Bookwalter retractor was placed to expose the right external iliac artery and vein. As vessels were soft and calcified, Satinsky clamps were placed and vascular clamps on the artery, distal and proximally were placed. Arteriotomy was made. The kidney was removed off ice. We sewed the artery end-to-side with the Carrel patch with running 6-0 Prolene suture.
Subsequently, did a venotomy. Heparinized saline was used to flush it. The distal end of the inferior vena cava was used to sew the right external iliac vein end-to-side with a running 5-0 Prolene suture. Cross clamps were released. The warm ischemia time was 40 minutes and cold ischemia time was 14 hours. The kidney was perfused well, and prior to clamping, we started dopamine and Lasix 80 mg, 12.5 grams of mannitol was given IV. The kidney was pink and well perfused.
We repositioned our retractors to expose the bladder wall. We dissected through the detrusor muscle and mucosa of the bladder wall. The ureter was cut shorter and spatulated on the back wall. A 6 French double-J 12 cm length stent was placed in the transplanted kidney through the ureter and into the renal pelvis, and the distal end was placed into the bladder. Extravesical bladder anastomosis was then made with a running 6-0 PDS suture. The mucosa anterior to this was closed with interrupted 4-0 Vicryl suture.
A JP drain was brought out from a lateral stab incision. Both layers were closed as a single layer with a running #1 PDS suture. Subcutaneous tissue was irrigated. A separate JP drain coming out medially was brought in the subcutaneous tissue, 3-0 Vicryl simple interrupted subdermal stitches were used and staples for the skin. Blood loss was approximately 300 mL. Sponge and needle counts were correct x2. The patient was extubated and transferred to the recovery room in stable condition.
