Abdominal Organ Retrieval and Transplantation Bench Surgery E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 349

Veröffentlichungsjahr: 2013

Beschreibung

Abdominal organ transplantation is a complex, multi-step process that requires flawless surgery from start to finish. Training in organ retrieval and bench surgery, however, has varied from country to country and even center to center, and trainees too often must rely on hands-on experience without the benefit of extensive practical or theoretical training.

With the number of transplant programs on the rise and the demand for donor organs increasing steadily as outcomes continue to improve, there is a greater need than ever before for a practical and comprehensive reference that transplantation professionals can turn to for clear and comprehensive guidance.   Abdominal Organ Retrieval and Transplantation Bench Surgery fills that need.

This important new book covers all aspects of retrieval and bench surgery of the abdominal organs. Coverage includes organ retrieval logistics and organ preservation; retrieval and bench surgery of the kidney, liver, pancreas and intestine; in situ and ex situ liver splitting; multi-organ retrieval; paediatric age-specific aspects of retrieval and bench surgery; and more. Key features include:

• Practice learning points for each procedure
• Detailed color illustrations of standard techniques
• Thorough guidance on dealing with anatomical variations

Abdominal Organ Retrieval and Transplantation Bench Surgery is the ideal guide for surgeons and donor retrieval teams alike. With its step-wise approach and practical orientation, it is a reference transplant professionals can trust to help them understand and excel at all aspects of abdominal organ retrieval, from managing potential donors and properly retrieving organs to minimizing the likelihood of common pitfalls while mastering the latest surgical techniques.

Leseprobe

Contents

List of Contributors

Foreword

Preface

About the Companion Website

1 Organ Retrieval Logistics

Introduction

Diagnosis of death – DBD and DCD donation

Evolution of organ donation and the legal framework governing organ donation

Organ retrieval teams and organ transplantation units

Patient selection for transplantation and allocation of deceased donor organs for transplantation

2 Strategies in Preservation of Abdominal Organs

Introduction

A touch of preservation history

Donor related organ injury

Some basic principles in organ preservation

Hypothermia is still a key factor

Interstitial and cellular oedema

Cellular acidosis

Formation of oxygen free radicals

Preservation solutions

The static cold storage method of organ preservation

Machine perfusion revisited: a renaissance in preservation?

Practical consequences to consider during retrieval

Packaging of donor organs

A brief outlook on future practice

3 Management of the Brainstem Dead Organ Donor

Physiological changes associated with brainstem death

Organ damage

Clinical management and use of guidelines

A practical approach to brainstem dead donor management

Physiological support in the operating theatre

Implementation and outcomes

Future research and development of guidelines

4 Multiorgan Retrieval

Introduction

Retrieval team

Retrieval logistics

Pre-retrieval checks

Multiorgan retrieval technique in DBD donors

Perfusion fluids

Bench surgery

Paperwork and documentation

5 Kidney Retrieval and Bench Surgery

General principles and logistics

Procedure

Special considerations with kidney retrieval

Most common forms of damage following kidney retrieval

Rewarming of kidney

Bench surgery for the kidney

Dealing with common bench surgery problems

Pre-implantation biopsy

Donation after cardiac death and kidney retrieval

6 Liver Retrieval and Bench Surgery

Liver retrieval

Bench surgery

7 Deceased Cardiac Donor Liver Retrieval

Introduction

Controlled DCD

Normothermic regional perfusion (NRP)

Bench perfusion and packing

Uncontrolled DCD

Preservation solutions

Assessment of DCD liver grafts

8 In situ Liver Splitting

Introduction

Donor and recipient evaluation

Surgical techniques

9 Ex situ Liver Splitting

Introduction

Selection of the deceased donor

Recipient selection

Technique of the ex situ left lateral split procedure

Technique of the ex situ full left–full right split procedure

Outcome of split liver recipients

10 Pancreas Retrieval and Bench Surgery

Background

Organ procurement

Organ preservation

Bench surgery

Islet transplantation

11 Intestinal Retrieval and Bench Surgery

Introduction

Intestine donor selection

Intestine donor preparation

Isolated intestine grafts (ISO-INT)

Liver–intestine grafts (LIV-INT)

Multivisceral grafts (MVT)

12 Pediatric Age-Specific Aspects of Retrieval and Bench Surgery

Introduction

Donor selection for pediatric solid organ transplantation

Relevant aspects for organ procurement and techniques

Relevant aspects for bench procedures

Index

This edition first published 2013, © 2013 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Abdominal organ retrieval and transplantation bench surgery / edited by Gabriel C. Oniscu, John L. Forsythe, John Fung. p. ; cm. Includes bibliographical references and index.

ISBN 978-0-470-65786-7 (cloth) I. Oniscu, Gabriel C. II. Forsythe, John L. R. III. Fung, John Julian, 1956– [DNLM: 1. Abdomen–surgery. 2. Organ Transplantation–methods. 3. Tissue and Organ Harvesting–methods. WI 900] 617.5′5–dc23

2012048832

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover design by Andy Meaden.Photograph supplied by Dr Gabriel Oniscu. Copyright © 2012, Gabriel Oniscu.

List of Contributors

Murat Akyol MD, FRCSConsultant Transplant Surgeon, Royal Infirmary of Edinburgh; Honorary Clinical Senior Lecturer in Surgery, College of Medicine and Veterinary Medicine, University of Edinburgh, UKDieter C. Bröering MD, PhDOrgan Transplant Center, King Faisal Specialist Hospital and Research Center, Saudi ArabiaDouglas G. Farmer MDProfessor of Surgery, Director, Intestinal Transplant Program, Dumont-UCLA Transplant Center, USAJohn L. Forsythe MD, FRCSHonorary Professor, Consultant Transplant Surgeon, Transplant Unit, Royal Infirmary of Edinburgh, UKPeter J. Friend MD, FRCCSProfessor of Transplantation, Nuffield Department of Surgical Sciences, University of Oxford; Oxford Transplant Centre, Churchill Hospital, UKJohn Fung MD, PHDDirector, Transplantation Centre, Chair, Digestive Disease Institute, Cleveland Clinic, USAChiara Grimaldi MDTransplant Center and Pediatric Surgery Department, Children’s Hospital Bambino Gesù, University of Roma Tor Vergata, ItalyKoji Hashimoto MDDepartment of General Surgery, Digestive Disease Institute, Cleveland Clinic, USAPrawat Kositamongkol MDInstructor, Hepato-Pancreato-Biliary Surgery and Transplantation Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, ThailandDermot McKeown FRCAConsultant in Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, UKPaolo Muiesan MDConsultant Liver Transplant Surgeon, Liver Unit, Queen Elizabeth Hospital, UKGabriel C. Oniscu MD, FRCSConsultant Transplant Surgeon, Honorary Clinical Senior Lecturer, Transplant Unit, Royal Infirmary of Edinburgh, UKRutger J. Ploeg MD, PhD, FRCSOxford Transplant Centre, University of Oxford and OUH Trust, John Radcliffe and Churchill Hospitals, UKVictor L. Tswen Wen MBBS, MMed(Surg), FRCS(Ed), MSc(Bioinformatics), FAMSConsultant, Division of Hepatobiliary and Pancreatic Surgery, Liver Transplant Programme, Department of Surgery, National University Hospital; Visiting Senior Lecturer, Nanyang Technological University, SingaporeJean de Ville de Goyet MD, FRCSProfessor of Surgery, Transplant Center and Pediatric Surgery Department, Children’s Hospital Bambino Gesù, University of Roma Tor Vergata, ItalyThomas Vogel MDConsultant Surgeon, Clinic and Polyclinic for General and Visceral Surgery, University of Münster, GermanyHasan Yersiz MDProfessor of Surgery, Dumont-UCLA Transplant Center, USANeil Young MRCP(UK),FRCA, DICMConsultant in Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, UK

Foreword

I am delighted to see a book concentrating on the techniques and associated problems of organ retrieval and donor management, and especially the inclusion of techniques of bench surgery. This book starts with the logistics of organ retrieval and then moves through donor management (including the diagnosis of brainstem death), multiorgan retrieval and organ preservation. The various techniques of bench surgery related to the kidney, the liver and especially splitting of the liver both in situ and ex situ are very well described. The increased activity in pancreas transplantation and intestinal transplantation warrants detailed descriptions of techniques of retrieval and the relevant bench surgery, and these topics are well covered. Finally, there is a chapter on retrieval of organs from children and the associated bench surgery which often presents greater technical difficulties.

This book is a very welcome addition to the transplantation literature and fills a much needed gap. It should be essential reading for all transplantation units and especially for transplantation surgical trainees.

Peter J. Morris AC, FRS, FRCSDirector, Centre for Evidence in Transplantation,Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine;Past President, the Royal College of Surgeons of England;Nuffield Professor of Surgery Emeritus, University of Oxford;Honorary Professor, University of London

Preface

Over the last 50 years, transplantation has been at the forefront of innovation in medicine. Advances in surgical techniques, immunosuppression and a holistic care of the transplant recipient have ensured the continued success of life-saving and life-enhancing transplantation. However, none of this would have been possible without the donors’ gift of life and the efforts and dedication of the teams that ensure successful organ recovery.

Organ retrieval is the bedrock of transplantation. New techniques, such as multivisceral retrieval and in-situ and ex-situ liver splitting, have been developed in an effort to expand the donor pool and reach more patients. Bench surgery, an understated element of the transplantation pathway, has seen innovative changes to deal with more and more complex anatomical situations in an effort to provide more organs for transplantation. Deceased circulatory failure donation has seen a resurgence in the last few years, fueled in part by significant advances in organ preservation.

In many ways, abdominal organ retrieval is on the brink of a revolutionary change, with advances such as regional normothermic perfusion and warm pulsatile preservation paving the way.

In this context, this book provides a timely review of the current status of organ retrieval and bench surgery techniques in a step-wise approach and introduces novel practices, to illustrate the changing landscape in the field.

Conceived as a practical guide for retrieving surgeons of all levels of experience, the book follows the journey of the donated organs from retrieval to preparation for implantation, and as such will help all transplant professionals to understand the management of potential donors, be familiar with standard retrieval techniques, understand anatomical variations and learn effective ways of dealing with them. Each step of the surgical procedures is illustrated with high quality intraoperative pictures and diagrams, whilst decision algorithms are provided for difficult clinical scenarios. A novel aspect is the provision of evidence-based information, which is clearly identified in the text. Practical tips and learning points are highlighted throughout the text, in yellow and green boxes respectively, and each chapter finishes with an ‘in a nutshell’ summary.

We hope that the format of this book will provide an easy reference point to those involved in every aspect of abdominal organ retrieval and bench surgery and, as such, will promote excellence in this challenging area of transplantation surgery.

Gabriel C. OniscuJohn L. Forsythe

About the Companion Website

This book is accompanied by a companion website:

www.wiley.com/go/oniscu/abdominal

The website features video clips to accompany four chapters:

Multiorgan retrieval

Kidney bench surgery

Liver bench surgery

Pancreas bench surgery

1

Organ Retrieval Logistics

Murat Akyol1 and Victor L. Tswen Wen2

1Royal Infirmary of Edinburgh; College of Medicine and Veterinary Medicine, University of Edinburgh, UK2Division of Hepatobiliary and Pancreatic Surgery, Liver Transplant Programme, Department of Surgery, National University Hospital; Nanyang Technological University, Singapore

Introduction

There are very few countries where organ donation is not covered by the provisions of law or is expressly prohibited. However, healthcare infrastructure or cultural and religious traditions have prevented widespread adoption of the practice in many societies. Substantial differences exist in donation rates even amongst countries of similar socio-economic status, sharing a similar cultural and religious heritage and similar legislative framework. Such differences testify to the important role of logistics in the success of organ transplantation.

Organ transplantation involves two surgical procedures: the retrieval of an organ from a donor and implantation of the organ to a recipient.

This chapter specifically deals with logistical issues surrounding organ retrieval. The details of the surgical procedures required to retrieve organs are covered in subsequent chapters of the book. The logistical issues discussed refer to organ retrieval from deceased donors only.

Diagnosis of death – DBD and DCD donation

It is acknowledged worldwide that the irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity to breathe equates to death. Irreversible loss of brainstem functions ­produces this state. Therefore demonstration that the functions of the brainstem have irreversibly ceased allows diagnosis of death.