title: Laparoscopic renal autotransplantation.
abstract: OBJECTIVE
  Renal autotransplantation is an extensive open surgical operation consisting of two distinct procedures, live-donor nephrectomy and autotransplantation, and requiring two large skin incisions. Herein, we analyze the feasibility of performing the entire procedure laparoscopically.
  
  
  METHODS
  Renal autotransplantation was performed entirely laparoscopically in six female farm pigs. Following a left donor nephrectomy, intracorporeal renal hypothermia was achieved by intra-arterial perfusion of ice-cold solution through a 4F balloon catheter. During autotransplantation, the renal vessels were anastomosed intracorporeally to the previously prepared ipsilateral common iliac vessels in an end-to-side fashion. Laparoscopic freehand suturing (5-0 Prolene) and knot-tying techniques were employed exclusively. A staged contralateral native nephrectomy was performed in five animals. Postoperative follow-up included serial creatinine measurements, intravenous urography, aortography, and renal histologic examination.
  
  
  RESULTS
  The mean operating time was 6.2 hours (range 5.3-7.9 hours), the venous anastomosis time was 33 minutes (range 22-46 minutes), the arterial anastomosis time was 31 minutes (range 27-35 minutes), and the total iliac clamping 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 contralateral nephrectomy 1.6 mg/dL. Intravenous urography and aortography prior to euthanasia (N = 5) demonstrated prompt contrast uptake and excretion by the autotransplanted kidneys and patent arterial anastomoses, respectively. Histopathologic examination of the autograft demonstrated normal renal architecture.
  
  
  CONCLUSIONS
  Renal autotransplantation can be performed utilizing laparoscopic techniques exclusively. This study may form the basis for performance of complex urologic vascular procedures laparoscopically.
authors.affiliation: Section of Minimally Invasive Surgery, Urological Institute, and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Meraney
authors.forename: I S
authors.initials: IS
authors.lastname: Gill
authors.forename: J H
authors.initials: JH
authors.lastname: Kaouk
authors.forename: M
authors.initials: M
authors.lastname: Skacel
authors.forename: G T
authors.initials: GT
authors.lastname: Sung
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001011:Aorta / Q000601:surgery; D001027:Aortography; D005260:Female; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D010535:Laparoscopy; D009392:Nephrectomy; D011184:Postoperative Period; D013552:Swine; D014182:Transplantation, Autologous; D014567:Urography