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Living-Related Renal Transplant, Placement of Ureteral Stent Operative Sample Report

DESCRIPTION OF OPERATION:  The patient was intubated under general endotracheal anesthesia. A Foley catheter and bladder irrigant solution was made. The patient's right groin was prepped and draped in the usual sterile fashion. For induction therapy, the recipient received 500 mg of Solu-Medrol and Simulect 20 mg IV.

A curvilinear incision in the right groin was made, one fingerbreadth above the pubis symphysis, two fingerbreadths medial to the anterior iliac spine to the left of the umbilicus. Dissection through subcutaneous tissue and external oblique was made. We entered the retroperitoneal space through the transverse abdominus muscle. A Bookwalter retractor was placed. Inferior epigastric and round ligament clamped and ligated. We exposed the right external iliac artery and vein and serially clamped lymphatics anterior to the artery and vein. In the adjoining room, Dr. Doe was performing a left donor nephrectomy. The kidney was removed; single artery and single vein. The kidney was flushed on the back table with cold lactated Ringer solution that had Solu-Medrol and lidocaine in it. The kidney flushed well until all the effluent fluid was out. There were no perfusion defects.

The kidney was brought into the adjoining room, where on the back table, I separated and then cleaned off the kidney further.  Fat from Gerota's fascia was removed. The ureter was cleaned off. The artery and vein were separated. Gonadal and lumbar branches' staples were removed, clips, and these were oversewn branches of the left renal vein. I further dissected the artery and vein and the small tributary venous branch was also ligated to further excise the artery from the vein. Dopamine was started. Vascular clamps were placed, Satinsky clamps on the vein, Fogarty-Hydragrip on the artery. Arteriotomy was made first.  A 4 mm coronary punch was used to open the orifice further. The left renal artery was sewn end-to-side to the right external iliac artery with a running 6-0 Prolene suture.

Venotomy was subsequently made on the left external iliac vein and end-to-side left renal vein to the right external vein was sewn end-to-side with a running 5-0 Prolene suture. The cross-clamps were released. Cold ischemia time was 50 minutes and warm ischemia time was 21 minutes. The kidney was pink, perfused well. We irrigated with warm saline and urine was being made on the table. Prior to unclamping, we also gave 80 mg of Lasix and 12.5 mg of mannitol.

We repositioned our retractors. We dissected the bladder wall and the mucosa. We cut the ureter short and spatulated the back wall, and an extravesical bladder anastomosis was made with a running 5-0 PDS suture. A 6-French double-J stent was placed into the recipient's transplanted ureter and renal pelvis and the distal end into the native bladder. As mentioned, running 5-0 PDS was used for extravesical bladder anastomosis. The mucosa anterior was closed with interrupted 4-0 Vicryl sutures.

A JP drain was brought in from a lateral stab incision. The fascia and both layers were closed as a single layer with running #1 PDS suture. The subcutaneous tissue was irrigated. The 3-0 Vicryl interrupted subdermal stitches were used and staples for the skin. Blood loss was approximately 150 mL. Sponge and needle counts were correct x2. The patient was extubated. The patient was making urine and was transported to the recovery room in stable condition.

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