Feasibility of Laparoscopic Combined Para-Orthotopic Pancreas and Orthotopic Kidney Transplantation: Initial Research with a Pig Model

BACKGROUND The aim of this study was to investigate the feasibility of laparoscopic combined para-orthotopic pancreas and orthotopic kidney transplantation in a pig model. MATERIAL AND METHODS Twelve white female pigs, (4-5 months old, weight range 40-45 kg) were used as donors and recipients, and 6 laparoscopic-combined pancreas and kidney transplantations were performed. After bilateral nephrectomy, the pancreatic artery and vein were anastomosed to the right renal artery and vein, respectively, and the pancreatic fluid was diverted to the duodenum or jejunum. The renal artery and vein were anastomosed to the left renal artery and vein, respectively. The ureter (or kidney pelvis) was anastomosed to the left native ureter (or kidney pelvis). The data of the operations were recorded, and grafts were inspected at autopsy. RESULTS Four of the 6 recipient pigs underwent the entire procedure. The duodenum-to-duodenum anastomosis was unfinished in 1 case, and both the duodenum-to-duodenum and renal pelvis-to-pelvis anastomoses were left unperformed in another case. The mean recipient operative time was 429±43 minutes. The mean venous and arterial anastomotic times were 69±15 minutes and 37±18 minutes, respectively, for pancreas transplantation and 56±09 minutes and 42±06 minutes, respectively, for kidney transplantation. The time for renal pelvis-to-pelvis anastomosis was 56±13 minutes and for duodenum-to-duodenum anastomosis was 90±13 minutes. The mean blood loss for recipient pigs was 98±35 mL. An immediate viable blood supply was seen in the 4 pancreatic grafts and in the 5 kidney grafts during the operation by the appearance of a bright red color after revascularization. Five pancreatic grafts had autopsy-proven reliable artery anastomoses and 4 reliable vein anastomoses. All 6 kidney grafts had autopsy-proven reliable artery anastomoses; however, 1 had a vein anastomotic stricture. CONCLUSIONS Our study showed that laparoscopic-combined para-orthotopic pancreas and orthotopic kidney transplantation in pigs is surgically possible.