Development of a Pig Model for Laparoscopic Kidney Transplant

Our aim was to describe a standardized laparoscopic kidney transplant procedure in a pig model.

Ten pigs underwent laparoscopic kidney autotransplant. A right-hand assisted nephrectomy was performed through a Pfannenstiel incision. After the graft was washed with Ringer lactate, it was transplanted into the right iliac vessels by pure laparoscopy. To maintain cold ischemia, a gauze-wrapped ice slush was placed below the allograft. The ureteroneocystostomy was performed through the Pfannenstiel incision. The contralateral ureter was ligated at the end of the procedure. After 24 hours, pigs were killed, and the allograft's perfusion function and presence of urine in the bladder were evaluated.

Procedures for 2 animals (20%) could not be completed because of technical problems in the vascular anastomosis; the other 8 procedures (80%) were completed successfully. Seven allografts (87.5%) were functioning 24 hours after surgery, with urine in the bladder and good perfusion of the allograft. The other kidney presented with a venous thrombosis that was detected after death. Mean surgical times were 56.2 ± 11.7 minutes for vein anastomosis and 44.7 ± 23.1 minutes for artery anastomosis. Mean ischemia time was 193 minutes. Total duration of the procedure was clearly decreased in the last 4 animals undergoing transplant.

Laparoscopic transplant is a difficult procedure that requires experience in kidney laparoscopy and laparoscopic vascular sutures. The experimental model presented is a good training option and can be used to evaluate different methods to maintain cold ischemia and to compare with the traditional open approach.