Step 6 Preparing the Allograft Extraction Site

The extraction site is prepared by making a 5 to 6 cm Pfannenstiel incision, which was outlined at the beginning of the procedure. The anterior rectus fascia is skeletonized, making sure to mobilize overlying subcutaneous tissue. The fascia is incised longitudinally in the midline, ensuring sufficient room for extraction of the kidney. The rectus muscle is separated in the midline, and the underlying peritoneum is left intact in order

FIGURE8 ■ Dissection of the ureter. An instrument is placed under the ureteral packet, including the clipped gonadal vein (GV), elevating it anteriorly because posterior attachments are dissected. The ureter (U) need not be visualized, because attempts to do so may compromise its delicate blood supply.

FIGURE9 ■ The kidney is elevated with a blunt instrument, assisting in skeletonizing the renal vessels. Abbreviations: RA, renal artery; RV, renal vein.

FIGURE8 ■ Dissection of the ureter. An instrument is placed under the ureteral packet, including the clipped gonadal vein (GV), elevating it anteriorly because posterior attachments are dissected. The ureter (U) need not be visualized, because attempts to do so may compromise its delicate blood supply.

FIGURE9 ■ The kidney is elevated with a blunt instrument, assisting in skeletonizing the renal vessels. Abbreviations: RA, renal artery; RV, renal vein.

Before initiating final delivery of the kidney, the surgical team must be alerted that the transplantation team is prepared to receive the allograft.

to preserve the pneumoperitoneum. A 15-mm trocar is placed under direct vision in the middle of the extraction incision.

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