Minimal-access kidney transplant.

OBJECTIVES

Minimal-access kidney transplant is not a new approach, however this approach is a good option for obese patients because access is difficult and often associated with wound complications and prolonged recovery.

MATERIALS AND METHODS

Minimal-access kidney transplant uses an inguinal incision that is placed 4-6 cm above the pubic bone that extends to 2.5-cm lateral to the mid-inguinal point. Once the skin and subcutaneous tissues are opened, the external oblique is split in the same direction as the wound. Then, the oblique and transverse abdominal muscles are split at the lateral edge of the wound, the abdominal muscles are separated from the lateral border of the rectus muscle, and the inferior epigastric vessels and round ligament are tied and cut. Mobilizing the peritoneum upward exposes the iliac vessels. Then, dissect the space between the urinary bladder and rectus muscle to create a pouch, which accommodates the kidney. The renal vessels are then clearly visible, while the kidney itself is hidden in the subrectus pouch. Suitable retractors are needed to perform these procedures. Then, arterial anastomosis can be performed. The clamps are released after testing the arterial and venous anastomoses. After securing hemostasis, the kidney can be left in the pouch, rotated laterally, or remain in the middle of the wound. Close only the external oblique muscle.

RESULTS

This technique requires minimal assistance and a small incision. An illustrative photo and diagram are included along with the full demographic data of the patients.

CONCLUSIONS

Engrafting kidneys into obese patients via the minimal-access approach is feasible, safe, and demonstrates comparable outcomes to other methods; however, more studies are needed.