0:00

So here we have a diagram of an alternative

0:03

surgical technique that can sometimes be

0:06

used for renal transplantation. We

0:09

don't do it that often, but we do see it

0:12

from time to time. So it's important to at least know what it looks like and will

0:15

also look at some of the ultrasound appearance of

0:18

this and so what's going on here is that you're actually removing

0:21

donor kidneys from a pediatric

0:24

patient. And so we sometimes use

0:27

these in the instance or you can't get an adult transplanted.

0:30

Kidney and the only alternative

0:33

is to get these pediatric kidneys from a child. And so and

0:36

that instance you typically remove both kidneys

0:39

we call on block pediatric on

0:42

block transplant. So both kidneys removed at once they're renal

0:45

artery and renal veins are also removed in the end fact

0:48

the Pediatric donors aorta and

0:51

IVC are also removed with these renal veins

0:54

and renal arteries over here. And then the anastomosis doesn't

0:57

take place between the donors.

1:00

Vein and the recipients external iliac

1:03

artery In Vein.

1:05

Rather the anastomosis takes place between the donors aorta

1:08

and the donors renal vein. So

1:11

that's what's actually used is the anastomosis in this instance.

1:14

And so when you're evaluating these you certainly want to evaluate, you

1:17

know, the inflow, which is the external iliac artery coming

1:20

over here anastomosis over here, which is

1:23

going to be between at external iliac already in the donor

1:26

aorta and you're gonna certainly try to evaluate

1:29

as much of the donor aorta as possible.

1:31

And then if possible the renal arteries here similarly with

1:34

the renal veins and so the anatomy is a little bit different in this

1:37

instance when you're transplanting pediatric kidneys into an

1:40

adult patient. And finally you also have to ask the most

1:43

ureters. Now you could do this one of two ways in this instance. I'm showing

1:46

you both ureters attacked separately to the bladder, but another

1:49

instances you could sort of an ask the most

1:52

ureters to one another and use that common trunk or common

1:55

ureter and an ass to most act to the bladder. And so

1:58

this is just a diagram of a pediatric unblock transplant that

2:01

sometimes can be used, you know, as a donor essentially to

2:04

place renal transplants in adult patients.