Nephrectomy in a Porcine Model: A Surgical Procedure to Retrieve Porcine Kidney Graft for Transplantation

All procedures involving animal models have been reviewed by the local institutional animal care committee and the JoVE veterinary review board.

1. Nephrectomy and kidney graft retrieval

1. Following surgical disinfection and draping, perform a median laparotomy to open the abdomen (25-30 cm). Use a standard abdominal retractor to expose the surgical field.
2. Use wet and warm abdominal towels to cover the colon and the small bowel. Ask the second assistant to hold the bowel to the direction of right hemi-abdomen exposing the kidney and its vascular structures.
3. Open the peritoneal layer and dissect the left kidney and the ureter from any adherent tissue using the monopolar cautery, bipolar forceps, and fine scissors.
4. Ligate and divide the left ureter (3-0 polyglactin) leaving an at least 10 to 12 cm long segment.
5. Complete the dissection of the left renal vein(s) and artery to their origin from inferior vena cava and aorta, respectively.
   NOTE: Avoid injury and opening of the large lymphatic vessels in this anatomical region. Also be aware of a potential injury to the azygo-lumbar vein joining to the renal vein near to its origin from the vena cava.
6. Dissect and ligate the azygo-lumbar vein between two ligatures (3-0 polyglactin).
7. Prepare for the back-table dissection using a bowl of ice and a sterile cover.
8. To retrieve the graft kidney, clamp the renal artery and the renal vein close to the aorta and the vena cava with vascular clamps. Remove the kidney graft by cutting the vessels with a scissor close to the clamps then hand the kidney over to the back-table team.
9. Close the stump of the renal artery using a 5-0 polypropylene suture. Close the renal vein using a two-layer continuous suture with 5-0 polypropylene. Remove the vascular clamps.
10. After checking the area for bleeding or lymphatic leakage, close the abdomen in 4 layers.
    NOTE: Peritoneum: 3-0 polyglactin running suture; fascia: 0 polyglactin running suture; subcutaneous layer: 3-0 polyglactin running suture; skin: skin staplers after kidney retrieval surgery, to facilitate re-opening the abdomen the following day and 2-0 polypropylene single knot sutures after the transplantation procedure for definitive closure.