Laparoscopic renal autotransplantation

Background and Purpose: Renal autotransplantation is an extensive open surg ical operation consisting of two distinct procedures, live-donor nephrectom y and autotransplantation, and requiring two large skin incisions. Herein, we analyze the feasibility of performing the entire procedure laparoscopica lly. Materials and Methods: Renal autotransplantation was performed entirely lap aroscopically in six female farm pigs. Following a left donor nephrectomy, intracorporeal renal hypothermia was achieved by intra-arterial perfusion o f ice-cold solution through a 4F balloon catheter. During autotransplantati on, the renal vessels were anastomosed intracorporeally to the previously p repared ipsilateral common iliac vessels in an end-to-side fashion. Laparos copic freehand suturing (5-0 Prolene) and knot-tying techniques were employ ed exclusively. A staged contralateral native nephrectomy was performed in five animals. Postoperative followup included serial creatinine measurement s, intravenous urography, aortography, and renal histologic examination. Results: The mean operating time was 6.2 hours (range 5.3-7.9 hours), the v enous anastomosis time was 33 minutes (range 22-46 minutes), the arterial a nastomosis time was 31 minutes (range 27-35 minutes), and the total iliac c lamping time was 77 minutes (range 62-88 minutes). The total renal ischemia time was 68.7 minutes: warm ischemia 5.1 minutes, cold ischemia 33 minutes and rewarming 31 minutes. Serum creatinine concentrations remained stable: baseline 1.3 mg/dL, after autotransplantation 1.1 mg/dL, and after contral ateral nephrectomy 1.6 mg/dL, Intravenous urography and aortography prior t o euthanasia (N = 5) demonstrated prompt contrast uptake and excretion by t he autotransplanted kidneys and patent arterial anastomoses, respectively. Histopathologic examination of the autograft demonstrated normal renal arch itecture. Conclusions: Renal autotransplantation can be performed utilizing laparosco pic techniques exclusively. This study may form the basis for performance o f complex urologic vascular procedures laparoscopically.