Right iliac fossa renal transplant was performed for a 61 year old recipient. It was a live related renal transplant with wife as a donor. The operative video demonstrates the important surgical steps in brief.
The first step involves opening up the right iliac fossa extending from the lateral aspect of the pubic tubercle to the direction of the tip of the 11th rib. Following this, the abdomen is opened in layers and the external iliac vessels are exposed in the retroperitoneal space. This is followed by the preparation of iliac vessels for anastomosis of external or internal iliac vessels to the donor renal artery or vein. The bladder Is prepared for the ureteroneocystostomy. The prepared graft after bench surgery is then anastomosed to the recipient bed.
The Donor renal artery is anastomosed to either the internal or external iliac artery. We prefer using Prolene 6-0 sutures for the anastomosis and An end to side anastomosis to the external iliac artery is our first preference. The renal vein from the donor is anastomosed end to side to the external iliac vein Using prolene 5-0 suture. The ureter is then anastomosed in a non-refluxing fashion to the dome of the bladder via the modified Lich-Gregoir Technique.
A DJ stent is also inserted in the ureter in the majority of cases and is removed after 2 weeks. We routinely insert a drain in the retroperitoneal space which is removed when the drain output is less than 100 ml in 24 hours. Most patients have good urine output in the immediate postoperative period and are discharged on the seventh postoperative day.