A new technique for end‐to‐end ureterostomy in the rat, using an indwelling reabsorbable stent

Carmignani, G.; Farina, Furio Pirozzi; Stefani, Stefano De; Maffezzini, Massimo

doi:10.1002/micr.1920040406

Cited by 11 publications

(21 citation statements)

References 3 publications

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“…As in our study, the use of the donor bladder cuff has facilitated restoration of the urinary tract continuity with ease of anastomosis. 13,14 In our experience, urine leak was encountered in one RT, which was associated with mortality. Native nephrectomy of the right kidney performed after 10 days of RT can provide the kidney time to recover from acute kidney injury.…”

Section: Discussionmentioning

confidence: 81%

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

Shrestha

Haylor²

2019

Exp Clin Transplant

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Objectives: Rat models of renal transplant are used to investigate immunologic processes and responses to therapeutic agents before their translation into routine clinical practice. In this study, we have described details of rat surgical anatomy and our experiences with the microvascular surgical technique relevant to renal transplant by employing donor inferior vena cava and aortic conduits. Materials and Methods: For this study, 175 rats (151 Lewis and 24 Fisher) were used to establish the FisherLewis rat model of chronic allograft injury at our institution. Anatomic and technical details were recorded during the period of training and establishment of the model. Results: A final group of 12 transplanted rats were studied for an average duration of 51 weeks for the Lewis-to-Lewis isografts (5 rats) and 42 weeks for the Fisher-to-Lewis allografts (7 rats). Functional measurements and histology confirmed the diagnosis of chronic allograft injury. Conclusions: Mastering the anatomic details and microvascular surgical techniques can lead to the successful establishment of an experimental renal transplant model. Key words: Animal model, Kidney transplant, Translational research IntroductionRenal transplant (RT) is the best form of renal replacement therapy for end-stage renal disease because it can improve quality of life, has a survival advantage, and is cost effective. 1 The present success of RT has evolved through advancements in the milestones of surgical techniques relevant for RT, understanding of the immunologic processes, immunosuppressive agents, tissue typing and crossmatch techniques, and ongoing research in the field of induction of tolerance, xenotransplantation, and organ bioengineering. 2 Experimental RT in rats has played a vital role in enhancing the understanding of the immunologic processes and application of immunosuppressive agents in clinical human RT. [3][4][5] For a successful RT in rats, in addition to paying attention to the pre-, intra-, and postoperative care of donors and recipients, a thorough understanding of the details of the anatomy is mandatory to successfully complete donor nephrectomy and recipient RT procedures.In rats, the anatomy of the retroperitoneum and the blood supply to the kidney, ureter, and bladder resemble those of humans; therefore, the principles of dissection during organ retrieval and implantation are similar. Lack of appropriate experience and skill is conducive to complications in donors and recipients and early transplant failure. 6 Our group has been involved in establishing a rat model of chronic allograft injury (CAI), and the experience gained during its successful establishment has been invaluable. Here, we describe the details of the surgical anatomy of the rat and our experience with microvascular surgical techniques of donor nephrectomy and implantation in the recipient by employing donor aortic and inferior vena cava conduits, which are relevant to experimental RT in rats. Materials and Methods AnimalsMale inbred Fisher (RT11v1) and Lewis (...

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Section: Discussionmentioning

confidence: 81%

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

Shrestha

Haylor²

2019

Exp Clin Transplant

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“…42 Various microvascular techniques of arterial anastomosis have been described, including end-toend anastomosis between donor-to-recipient renal arteries (sutured, cuffed, or sleeved techniques), endto-side anastomosis between the donor recipient artery with an aortic patch to the recipient aorta, interposition of donor aortic segment with the renal artery between the transacted segment of recipient aorta, and end-to-side anastomosis between donor aortic conduit containing renal artery and the recipient aorta. 7,40,41,43,44 The presence of more than 1 renal artery, which is not uncommon, makes end-toend anastomosis impossible because of the narrow caliber and risk of thrombosis. 45 Karatazas and associates used donor aortic conduit attached to the renal artery and anastomosed end-to-side to the recipient abdominal aorta, which resulted in a survival rate of 87% at 15 days with no evidence of ischemic injury on histology.…”

Section: Discussionmentioning

confidence: 99%

“…Preserving the testicular artery in the donor aortic stump helps to maintain blood supply of the ureter. 40 A wellorganized training program with a staged microvascular anastomosis skill development curriculum has been shown to be beneficial to the trainees. 9 We have reviewed the published literature on the surgical techniques of RT in the rat and have shown that there are several variations regarding vascular and ureteric anastomosis techniques.…”

Section: Discussionmentioning

confidence: 99%

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Shrestha

Haylor²

2017

Exp Clin Transplant

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Microvascular surgical techniques of renal transplant in rats have evolved over the past 5 decades to achieve successful rat renal transplant; these modifications have included surgical techniques to address the anatomic variations in the renal blood vessels and those to reduce ischemic and operation durations. Here, we review the surgical techniques of renal transplant in rats and evaluate the advantages and disadvantages of individual techniques of vascular and ureteric anastomoses. For this review, we performed a systematic literature search using relevant medical subject heading terms and included appropriate publications in the review. Since the first description of a rat model of renal transplant by Bernard Fisher and his colleagues in 1965, which used end-to-side anastomosis between the renal vein and renal artery to the recipient inferior vena cava and aorta, several vascular and ureteric anastomosis techniques have been modified. Vascular anastomosis techniques now include end-to-end anastomosis, use of donor aortic and inferior vena cava conduits, sleeve and cuff anastomoses, and application of fibrin glue. Likewise, restoration of the urinary tract can now be achieved by direct anastomosis of the donor ureter to the recipient bladder, end-to-end anastomosis between the donor and recipient ureters, and donor bladder cuff to the recipient bladder. There are advantages and disadvantages attributable to individual techniques. The range of vascular and ureteric anastomosis techniques that has emerged reflects the need for mastering more than one technique to suit the vascular anatomy of individual animals and to reduce operating time for achieving successful outcomes after renal transplant.

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“…12 Right: The anastomosis was completed with interrupted sutures, after cannulation with a catgut thread (Carmignani et al, 1983). …”

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confidence: 99%

Improved renal transplantation in the rat with a nonsplinted ureteroureterostomy

Gu¹,

Dahmen²,

Dirsch³

et al. 2002

Microsurgery

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Orthotopic renal transplantation in the rat is a widely used model in immunology and transplantation-related research. Although numerous modifications of the surgical technique of ureteric reconstruction were evaluated, ureter complications following this reconstruction still occurred frequently. Instead of dividing the ureter in the middle between kidney and bladder (method 1), the anastomosis was performed close to the renal pelvis after cutting the ureter obliquely (method 2), which enlarged the diameter of the ureteral anastomosis 2-fold. The incidence of stenosis of ureteric anastomosis was 12.5% (3/24) using method 1, whereas this complication was avoided completely (0/45) using method 2. Furthermore, the risk of injury to the ureter was reduced, as isolation of the ureter was limited. These modifications improved the last delicate step in the procedure of rat kidney transplantation.

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A new technique for end‐to‐end ureterostomy in the rat, using an indwelling reabsorbable stent

Cited by 11 publications

References 3 publications

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

Surgical Anatomy and Microvascular Surgical Technique Relevant to Experimental Renal Transplant in Rat Employing Aortic and Inferior Venacaval Conduits

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Improved renal transplantation in the rat with a nonsplinted ureteroureterostomy

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