Transplantation Bench Surgery of the Abdominal Organs

Abstract

Liver bench surgery: carefully dissect the donor inferior vena cava, especially in the suprahepatic region, where the adventitia is firmly adherent to the surrounding diaphragm, and on the posterior side to avoid uncontrollable posterior bleeding during implantation. Recognize hepatic artery variations (Michel’s classification) when examining the superior mesenteric artery. Dissect the hepatic artery from the aortic patch to the level of bifurcation of the gastroduodenal artery, cleaning off the celiac plexus and fibrofatty tissue enveloping the vessels. Do not ligate the small collaterals too near to the vascular ostia, especially in atheromasic arteries.

Kidney bench surgery: carefully remove the perinephric fat without skeletonizing the ureters; avoid extensive opening and massive cleaning of perinephric fat in kidneys from older donors. Mark and subtend both the ureters with light mosquito forceps to avoid their accidental shortening and injury. Cut the left renal vein along the left margin of the vena cava. Choose the right renal vein elongation technique that is most appropriate according to the shape of the vein. Pay special attention to the inferior polar arteries, which often originate far from the main renal artery, from the inferior abdominal aorta, or from the iliac axis.

Pancreas bench surgery: manipulate the pancreas parenchyma very carefully to minimize edema, injuries, and bleeding, all factors which increase the risk of acute pancreatitis of the graft.