Surgery setup images for Kidney Transplant
Mayo stand and back table instruments for Kidney Transplant surgery setup
Clamping & Occluding
Debakey Bulldog Clamp
Hemostatic Clip Applier
Mosquito Clamp – Curved
Right Angle Clamp
Cutting & Dissecting
Grasping & Holding
Retracting & Exposing
Suturing & Stapling
What to expect during Kidney Transplant
A kidney transplant is a surgical procedure in which a healthy kidney is transplanted into a person with kidney failure. The healthy kidney is usually donated from a deceased or living donor. The transplanted kidney is placed in the lower abdomen and connected to the recipient’s blood vessels and bladder. The new kidney then takes over the job of filtering waste and excess fluids from the body. Kidney transplantation is considered a successful treatment for end-stage kidney disease, as it can significantly improve the quality of life and increase lifespan compared to dialysis. However, the procedure also involves risks and requires lifelong medication to prevent rejection of the transplanted kidney.
Step 1: Preparing the Donor Kidney
The donor kidney will be brought to the operating room and will be prepared for implantation into the recipient. This involves cleaning off any excess fat and dissecting the vessels clean. The vessels may be shortened to make the anastomosis easier. If the kidney came from a deceased patient, an aortic cuff may be used.
Step 2: Reconstructing the Veins
The veins need to be reconstructed, and there will be branches that will need to be ligated, but a large renal vein will be kept.
Step 3: Placing the Kidney
The kidney will either be placed in the iliac fossa or in the retroperitoneum.
Step 4: Making the Incision
A large incision with a 10 blade will be made, and the external oblique muscle and fascia are dissected. The internal oblique and transverse muscles will be divided to expose the peritoneum. The inferior epigastric will be ligated, and the spermatic cord will be preserved.
Step 5: Anastomosing the Renal Artery and Vein
The renal artery and vein will be anastomosed. The renal vein will be attached to the external iliac vein, usually with a small 5-0 Prolene suture. The artery will be attached to the external iliac artery. The aortic cuff will be trimmed and fitted to the renal artery and then attached to the arteriotomy in the external iliac artery.
Step 6: Reconstructing the Urinary Tract
Now, the urinary tract will be reconstructed. The bladder will be incised, and the patients’ ureter is found. An incision is made in it. The donor ureter will be fed through the incision into the bladder and anastomosed with absorbable suture. The bladder incision is then closed, and the bladder is filled to check for leaks.
Step 7: Closing the Incision
The tissue will be reapproximated and closed with suture.Common sutures used for 5-0 and 6-0 Prolene, 1 and 4-0 PDS, 2-0 and 3-0 silk ties, and #5 Ethibond or Nylon.
Tips and tricks
It’s important to place booties on some mosquitos for clamping suture, and ties should always be available on the sterile field.
The Surgery Sparknotes
- Prepare donor kidney by cleaning off fat and shortening vessels.
- Place kidney in iliac fossa or retroperitoneum through large incision.
- Dissect external oblique muscle and fascia, divide internal oblique and transverse muscles to expose peritoneum, ligate inferior epigastric and preserve spermatic cord.
- Anastomose renal artery and vein to external iliac artery and vein using small Prolene suture.
- Trim and fit aortic cuff to renal artery and attach it to arteriotomy in external iliac artery.
- Reconstruct urinary tract by incising bladder, finding patient’s ureter, making an incision in it, feeding donor ureter through it, and anastomosing it with absorbable suture.
- Close bladder incision and check for leaks.
- Reapproximate tissue and close with suture.
- Use booties for clamping suture and ensure ties are available on the sterile field.