I. STERILIZATION / DISINFECTION
It is mandatory to maximize the hygienic measures to ensure the transplantation success
In experimental surgery it is not possible to work in a sterile environment. The main reasons are:
a/rats are more resistant to infection than human.
b/the cost/benefit of conditioning the operating room is not profitable.
How to do it:
a/ disinfect the operating area at the beginning (surfaces, devices, etc...).
b/ use as many sterile material as (solutions, gauzes, sutures, syringes, needles, gloves, etc...).
c/ disinfect all the other non-sterile material (surgical instruments, receptacles, ...).
d/ disinfect the surgical instruments between the kidney procurement and the transplant.
II. PRECISION AND REPETITIVITY
It is very important to maintain the surgical material in the best conditions.
How to do it:
a/ do not use the transplantation surgical instrumental for other surgery o procedures.
b/ do not allow any other person than you manipulates the transplantation surgical devices.
c/ take personal care of your surgical instrumental (wash, maintenance, storage, etc...).
It is necessary that all the procedures are done with carefulness to success.
How to do it:
a/ dispose all devices always in the same position to avoid wasting time in localizing it.
b/ follow a routine of methodical and repetitive movements to reduce time and intra-experimental variations.
III. ANATOMICAL POSITION
While talking about the anatomical position of rats and their organs, the following nouns are used:
a/ cranial: refers to the superior part of the rat, where the head and superior extremities are placed.
b/ caudal: refers to the inferior part of the rat, where the tail and hind legs are placed.
c/ dorsal/ventral: refers to the back and belly respectively. When the rat is placed in decubito prono we can access to the dorsal zone, while in decubito supino we can acces.
d/ left/right: always referring to the natural position of the rat looking at it from the dorsal area and placing the cranial zone up right. Notice that in decubito supino the rat left kidney is the one at the right of the abdominal vessels.
IV. ANATOMY OF THE RENAL AREA
The transplantation has different names depending on where the graft is anastomozed:
a/ orthotopic transplant: the graft is transplanted in its natural place. In renal transplant, the donor kidney will substitute the recipient native one, which has been previously nephrectomized.
b/ heterotopic transplant: the graft is transplanted in a place different from its natural position. This is the case of human renal transplant. The native kidney nephrectomy is not mandatory and will depend on the study design in experimental transplantation.
Depending on the nature of the ends to anastomoze:
a/ end-to-end anastomosis: when both ends (vessels / urether / bowel /…) are faced one against the other in all their diameter.
b/ end-to-side anastomosis: when only one of both ends is cut in all its diameter and is faced against a lateral hole opened on the surface of the other element to anastomoze. For the end-to-side anastomosis of the renal artery an aortic patch is often used.The name aortic patch refers to the aortic spindly tissue at the end of the renal artery that is let there to facilitate the suture.
Depending on the style of the suture, this can be:
a/ continuous suture: an initial stitch is done letting one end long enough to use it again to finalize the suture at the same place by knotting both ends together. The filament covers all the perimeter to anastomoze and is only cut at the end of the suture.
b/ discontinuous suture: distinct isolated stitches are done around the perimeter to anastomoze. The filament is cut at each stitch.
c/ non suture: there are other different anastomosis techniques that do not require suture (i.e: cuff).
The isolated stitches can have different number of knots depending on the filament thickness. Ussually, the thinner the filament is the more number of knots are necessary. In rat kidney transplant the more often used are:
a/ single knot: 1 unique turn around the same filament. There are 3 single knots for each stitch of the urether discontinuous suture.
b/ double knot: 2 turns around the same filament. There are 3 double knots for each stitch at the end of continuous suture of vessels.