* These authors contributed equally
Large animal models play an essential role in preclinical transplantation research. Due to its similarities to the clinical setup, the porcine model of orthotopic kidney auto-transplantation described in this article provides an excellent in vivo setting for the testing of organ preservation techniques and therapeutic interventions.
In the present era of organ transplantation with critical organ shortage, various strategies are employed to expand the pool of available allografts for kidney transplantation (KT). Even though, the use of allografts from extended criteria donors (ECD) could partially ease the shortage of organ donors, ECD organs carry a potentially higher risk for inferior outcomes and postoperative complications. Dynamic organ preservation techniques, modulation of ischemia-reperfusion and preservation injury, and allograft therapies are in the spotlight of scientific interest in an effort to improve allograft utilization and patient outcomes in KT.
Preclinical animal experiments are playing an essential role in translational research, especially in the medical device and drug development. The major advantage of the porcine orthotopic auto-transplantation model over ex vivo or small animal studies lies within the surgical-anatomical and physiological similarities to the clinical setting. This allows the investigation of new therapeutic methods and techniques and ensures a facilitated clinical translation of the findings. This protocol provides a comprehensive and problem-oriented description of the porcine orthotopic kidney auto-transplantation model, using a preservation time of 24 hours and telemetry monitoring. The combination of sophisticated surgical techniques with highly standardized and state-of-the-art methods of anesthesia, animal housing, perioperative follow up, and monitoring ensure the reproducibility and success of this model.
Since the first successful human renal transplantation between identical twins in 1954, performed by the pioneering group of the Nobel prize laureate surgeon Joseph Murray1, kidney transplantation (KT) has evolved as the mainstay of treatment for patients with end-stage renal disease (ESRD)2. KT shows superior long-term clinical outcomes and quality of life compared to dialysis2. Short- and long-term survival rates after KT improved continuously, due to advances in surgical techniques, organ preservation, immunosuppressive therapy, and critical care, hence KT became widely available on a global scale2,3,4.
Due to critical organ shortage, there is a continuously increasing gap between allograft supply and demand3,5,6. In 2018, approximately 12,031 patients were waiting for KT in Germany, however, only less than 20% (2,291 patients) could receive a donor kidney due to the extreme shortage in organs for transplantation7. Unfortunately, not only the absolute number of organ donors, but also the general quality of the allografts offered for transplantation have declined in the past decades8,9. An increasing tendency was observed in the numbers of predamaged or "marginal" kidney allografts that had to be accepted for transplantation10. The use of ECD allografts may reduce waiting time and waiting list morbidity and mortality, it is, however, associated with an increased incidence of graft-related complications such as primary graft non-function (PNF) and/or delayed graft function (DGF)8,9,10. Further research is essential to optimize allograft utilization, expand the donor pool and protect and recondition marginal allografts which ultimately may improve patient outcomes3,6.
Due to the resource-intensive and complex nature of large animal transplantation models, a large number of studies are performed using small animals or in ex vivo settings11,12,13,14,15. Although these models can deliver important scientific data, the translation of these findings to the clinical setting is often limited. The porcine model of orthotopic kidney auto-transplantation is a well-established and reproducible model that allows to test new innovative treatment approaches in a clinically relevant in vivo setting, with potentially longer follow-up periods and abundant possibilities for repetitive sample collection16,17. Beyond the advantage of the comparable size, which allows relatively direct translation into the clinical setting (particularly for medical device development and drug dosage), the surgical-anatomical and physiological similarities in terms of ischemia-reperfusion injury (IRI) response and kidney damage, support the use of this model in translational research17,18,19. This model also provides an excellent training opportunity to prepare young transplant surgeons for the technical challenges of clinical organ transplantation20.
There are also multiple differences compared to the human setting and various technical modifications of the model can be found in the literature16,17,19,20,21. This article comprehensively describes technical details, pitfalls, and recommendations which can aid to establish the model of porcine orthotopic kidney auto-transplantation. The described telemetry and video monitoring method as well as our specifically designed housing facility allows a close-up severity assessment and clinical observation of the animals. The use of a percutaneous urinary catheter and designated porcine jackets provide the possibility of a detailed assessment of kidney function without the use of metabolic cages. These technical modifications are described as potential solutions to comply with the modern challenges of the 3R principle (Replacement, Reduction and Refinement) and improve animal experiments using large animal models22.
The present study was designed according to the principles of the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines23. Experiments were performed in accordance with the institutional guidelines and the German federal law regarding the protection of animals. The full ethical proposal was approved by the responsible authorities (Governmental Animal Care and Use Committee, LANUV NRW - "Landesamt für Natur, Umwelt und Verbraucherschutz Nordrhein-Westfalen", Recklinghausen, Germany, Protocol ID: 81-02.04.2018.A051). All animals in the present study received humane care according to the principles of the "Guide for the Care and Use of Laboratory Animals" (8th edition, NIH Publication, 2011, USA) and the Directive 2010/63/EU on the protection of animals used for scientific purposes (Official Journal of the European Union, 2010). Female German landrace pigs were obtained from a hygienically optimized barrier breeding facility (Heinrichs GbR, Heinsberg, Nordrhein-Westfalen). Figure 1 depicts the summary of the described experimental protocol.
1. Animals and housing
2. Basic techniques and common procedures
3. Telemetry implantation
4. Nephrectomy and kidney graft retrieval
5. Back-table and organ preservation
6. Contralateral nephrectomy and orthotopic kidney auto-transplantation
7. Follow up, sample and data collection
Our group has several years of experience with solid organ transplantation models in small- and large animals and utilized the porcine orthotopic kidney auto-transplantation model, obtaining reproducible results in various experimental settings16,25,26,27. Depending on the experimental setup, we recommend performing 3 to 5 auto-transplantations as preliminary experiments which ensures a sufficient learning curve of the whole experimental team. In the present setting 5 transplantations were required to train a surgeon, with 8 years of previous experimental- and 5 years of clinical surgical experience in the field of transplantation surgery, in performing these experiments. This can differ depending on the previous exposure of the surgeon to these techniques.
Within the frameworks of this protocol, the results of a set of 5 porcine orthotopic kidney auto-transplantation experiments are demonstrated. Transponder implantation was successful in each animal with sufficient telemetry signals throughout the observation period (except one animal with partial transponder dysfunction). Knife-to-skin interval for the transponder implantation was 85 min ± 5 min (Table 1). Following graft retrieval, all animals recovered well in the housing facility. Knife-to-skin interval for the retrieval surgery was 135 min ± 32 min (including approximately 30-45 min for the insertion, tunneling and securing of the jugular catheter). The left kidney was stored in a cold water-bath with a target cold ischemia time of 24 h (24 h ± 30 min). The following day, after anesthesia induction and relaparotomy, the contralateral (right) kidney was removed followed by the orthotopic auto-transplantation of the cold stored left kidney graft as described earlier. Knife-to-skin interval for the auto-transplantation surgery was 168 min ± 27 min (including the explantation of the right kidney). Warm ischemia time was 34 min ± 7 min. Each implanted kidney graft had a minimal but direct urine production following reperfusion. Following abdominal closure, color Doppler ultrasound showed satisfactory arterial and venous perfusion of the kidney in all cases (Figure 4). All animals recovered from the anesthesia and no significant complications were observed throughout the observation period. Daily blood and urine samples were collected. All pigs were in good clinical condition during the follow-up and were sacrificed after 5 days. Serum creatinine and potassium values peaked on POD3-4. The blood pH has remained within normal ranges (Figure 5). Urine output recovered to normal values over the first four postoperative days. White blood cell count was slightly increased at the end of the follow-up period (Figure 5). Body temperature, measured by continuous telemetry monitoring, showed slight fluctuations over the postoperative period.
Figure 1: Study flowchart and protocol. Abbreviations used: POD-postoperative day; ECG-electrocardiography. Please click here to view a larger version of this figure.
Figure 2: Animal housing facility with real-time and continuous telemetry monitoring of up to 6 animals. (A) Schematic blueprint of our facility suitable for the housing and telemetry monitoring of up to 6 animals. The size of the single holding boxes was determined based on the guidelines of the EU Directive 2010/63 and ETS 123 Appendix A. Panels A-E show representative images of the organization of our facility. (B) Animal room for the housing of 6 animals. (C) Observation room with a PC used for the continuous registration of telemetry data. (D) Real-time video and thermal footage of the animals. (E) Individual holding ensuring acoustic and olfactory contact of the animals with their companions to avoid social isolation. Please click here to view a larger version of this figure.
Figure 3: Orthotopic kidney auto-transplantation and anatomical variations and reconstruction possibilities. (A,B) The steps of the orthotopic kidney auto-transplantation model in case of a "standard" vascular anatomy. (C) Variation 1: while one larger vein comes with the donor kidney, there are two veins on the recipient side. Management: the smaller vein is closed by a ligature and the anastomosis is performed end to end between the renal veins. (D) Variation 2: while one larger vein comes with the donor kidney, there is no suitable recipient vessel on the contralateral side (e.g., size mismatch). Management: end to side anastomosis of the renal vein to the inferior vena cava. (E) Variation 3: two similar-sized veins on both sides. Management: reconstruction by two venous anastomoses. (F) Variation 4: while two similar-sized veins come with the donor kidney, there is no suitable recipient vessel on the contralateral side. Management: end to side anastomosis of the renal vein to the inferior vena cava in the case of two renal veins. (G) Variation 5: a donor kidney comes with a vein showing an early bifurcation, while there is one large vein on the contralateral side. Management: end to end anastomosis of the short common channel of the donor renal vein with one large vein on the recipient side. (H) Variation 6: while the donor kidney comes with a single renal vein with an early bifurcation, there is no suitable recipient vessel on the contralateral side. Management: end to side anastomosis of the short common channel of the donor renal vein to the inferior vena cava. This figure depicts a handful of the more frequent variations and is not statistically comprehensive in terms of all variations possible in German landrace pigs. Abbreviations used: KG-kidney graft; RK-right kidney; IVC-inferior vena cava; AO-aorta Please click here to view a larger version of this figure.
Figure 4: Representative color Doppler ultrasound images, directly after orthotopic kidney auto-transplantation and abdominal closure. (A) Color Doppler ultrasound is performed directly following the implantation of the kidney and abdominal closure, to ensure good arterial and venous perfusion of the kidney graft and to screen for potential iatrogenic vascular kinking. Ultrasound was also used daily and on-demand, based on the clinical performance of the animal to screen for various problems. (B-E) Representative ultrasound images of a kidney graft following implantation. The image of the kidney graft with and without color Doppler (B,C) shows an excellent arterial (D) and venous perfusion (E). This figure show representative images from the same animal. Please click here to view a larger version of this figure.
Figure 5: Representative laboratory findings and telemetry data of the orthotopic kidney auto-transplantation model with a cold ischemia time of 24 h. (A) Serum potassium values (B) Serum creatinine values (C) pH (D) White blood cell count (WBC) (E) Urine output. (F) Mean body temperature registered by telemetric monitoring throughout the observation period in four consecutive kidney transplantation (no data presented from the 5th animal due to partial transponder dysfunction). Abbreviations used: POD-postoperative day. Please click here to view a larger version of this figure.
Figure 6: Examples of possible peri-operative complications and pitfalls. (A-C) Postoperative congestion of the transplanted kidney graft on POD3 following orthotopic kindey auto-transplantation. (D) The reason for the congestion was identified as catheter kinking due to an overtightened suture on the level of the skin. After readjusting the suture the congestion resolved almost completely in 24 h. (E) Here an other kidney graft on POD2 following orthotopic kidney auto-transplantation is shown. Asterix (*) shows a fluid collection around the underpole of the graft (bloody collection vs. lymphocele). Because of our technique with closure of the peritoneum over the kidney these collections are usually self limiting due to the advantageous effects of local compression. Animals should be monitored closely in terms of the local finding, signs of bleeding or infection. (F) Qualified color Doppler ultrasound performed daily (and on demand) in the housing facility has, besides its academic utilization (e.g., documentation, registration of arterial resistence indices), a crucial diagnostic role in recognizing potential complications in the early subclinical phase. Please click here to view a larger version of this figure.
Experimental task/step | Days | Time (min) | Surgeon | Veterinary officer | Veterinary technician | Laboratory technician | Doctoral student | Total |
Nr | ||||||||
Preopreative care | D-29 to D-15 | n.a. | 1 | 1 | 1 | 3 | ||
Telemetry implantation surgery | D-15 | 85±5 | 1 | 1 | 1 | 1 | 1 | 5 |
Postoperative care following telemetry implantation | D-15 to D-1 | n.a. | 1 | 1 | 1 | 3 | ||
Graft retrieval surgery | D-1 | 135±32 | 1 | 2 | 1 | 2 | 2 | 8 |
Kidney auto-transplantation surgery | D 0 | 168 ±27 | 1 | 2 | 1 | 2 | 2 | 8 |
Postoperative care following kidney auto-transplantation | D 0 to D5 | n.a. | 2 | 1 | 2 | 5 | ||
Sacrifice | D 5 | n.a. | 2 | 1 | 1 | 4 |
Table 1. Description of the required human resources and time-schedules for performing various experimental steps of the porcine kidney auto-transplantation model.
The porcine model of KT allows the investigation of novel therapeutic approaches and medical devices in a clinically relevant large animal setting15,17,21. The anatomical, pathophysiological and surgical-technical similarities between the porcine and human setting can facilitate the clinical interpretation of data and the rapid translation of the findings and techniques into clinical testing15,16,17,18,19,21.
The model of orthotopic kidney auto-transplantation does not only comply with the 3R principle by reducing the numbers of required animals compared to allo-transplantation, e.g. no separate donor animal is required, but also provides a unique opportunity to investigate the effects of IRI and preservation injury without the confounding effects of the immunological response and immunosuppressive drugs17,21.
Slight modifications of the protocol allow modeling a broad spectrum of clinical situations. To mimic KT using donation after circulatory death (DCD) kidneys, vascular structures are clamped for 30 to 60 min in situ before kidney retrieval, while prolonged cold ischemia times (24 hours and longer) can be applied to model extensive preservation injury16,17,28,29.
Although, the porcine KT model is surgically less challenging than solid organ transplantation models in small animals (e.g. rats and mice)26, there are multiple technical aspects and pitfalls which have to be kept in mind to improve outcomes and avoid specific complications17.
Failing to avoid the large lymphatic vessels around the inferior vena cava and the aorta during graft retrieval or implantation due to technical mistake or anatomical variations, can lead to a high output lymphatic fistula and post-operative abdominal fluid collection, infection, and potentially technical failure. Lymphatic vessels should be completely avoided during surgery or closed with 5-0 or 6-0 polypropylene sutures. It is wise to also avoid the use of bipolar or any other coagulation device in case of lymphatic leaks. It usually leads to worsening of the situation. In case of a low output lymphatic leakage, our team has a good experience with the application of fibrin-based collagen patches (e.g., Tachosil)30, however, their high cost limits their application in this setting.
In the present protocol we demonstrate a transperitoneal approach for kidney retrieval and auto-transplantation. This is a major technical difference compared to the clinical situation, where kidney grafts are usually implanted into the iliac fossa using an extraperitoneal approach. Although, most groups use a transperitoneal and an orthotopic approach in the porcine model, heterotopic transplantation to the iliac fossa is also possible in pigs31. However, due to the relatively low diameter of the external iliac artery in 30-40 kg pigs and its tendency to vasospasm makes it sometimes difficult to perform the end-to-side anastomosis of the renal artery to the external iliac artery31. Concerning the fact that we retrieve the left kidney via a transperitoneal approach to perform a subsequent auto-transplantation, it is more feasible to perform the implantation by reopening the same incision and using a straigtforward orthotopic approach, especially that per-protocol it is also required to remove the native right kidney to ensure that the animal will recover with only one predamaged kindey. The comprehensive description of all possible technical variations of the model is beyond the scope of this protocol and has been summarized by others in comprehensive review articles31.
Dislocation of the transplanted kidney graft and consequential kinking of the vascular anastomoses is a major source of failure in the porcine KT model, rapidly leading to vascular occlusion and complete failure of the experiment, due to a surgical complication. To avoid this, following auto-transplantation we close the peritoneal layer over the kidney with a running suture using 3-0 polyglactin. Furthermore, color Doppler ultrasound is performed directly following the implantation of the kidney and abdominal closure, to ensure good arterial and venous perfusion of the kidney graft. Ultrasound is also used daily and on-demand, based on the clinical performance of the animal, to screen for kidney perfusion, post-renal problems (e.g. obstruction or kinking of the urinary catheter), and fluid collection due to lymphatic fistula, bleeding or infection (Figure 4 and Figure 6).
As 24 hours of cold ischemia often leads to functional impairment and delayed graft function, the animals may require on-demand medical therapy if it is considered necessary by the veterinary officer. This may include infusion therapy using 5% glucose and/or Ringer solution administered via the central venous line, furosemide bolus injections (in case of oliguria/anuria depending on the clinical state and laboratory results, 60-80 mg bolus injections up to 200 mg/day), and the oral administration of Sodium Polystyrene Sulfonate (Resonium A) in case of severe hyperkalemia32. To avoid experimental bias, the veterinary officer responsible for the post-transplant veterinary care of the animals must be blinded for the applied treatment and grouping.
Although, the anatomy of the renal artery is rather straightforward in German landrace pigs with usually one artery to reconstruct, there is a wide spectrum of anatomical variations of the renal vein branches which require certain surgical creativity during the venous reconstruction. Frequently two (or more) renal vein branches join on different levels between the kidney hilum and the inferior vena cava. The most frequently observed variations and the possible reconstruction options17 are shown in Figure 3.
Following the first surgical intervention (day -15, telemetry implantation), all animals receive a porcine jacket which they wear throughout the whole period of the experiments. This provides excellent protection against accidental injuries and dislocation of the implanted catheters and provides room for the storage of the urine collection bags. The use of these jackets is also a feasible solution to eliminate the need for metabolic cages for the assessment of creatinine clearance as a refinement method according to the 3R Principle.
Our housing facility integrates the use of telemetry and video-based peri-operative monitoring. Although, these methods cannot replace the regular visits by the veterinary officer and technicians, they facilitate rapid interventions and improve severity assessment to further refine our experimental settings for the future. There is a wide spectrum of indications for the use of an implantable telemetry device in large animal models33. Although, close monitoring of clinical paramters following major surgery such as ECG, blood pressure, temperature is considered to be standard in the human clinical setting of a surgical intensive- and intermediate care unit, in experimental surgery monitoring is mostly discontinued when the animal is waking up from anaesthesia33,34,35. Therefore, telemetry provides a feasible way for the continuous monitoring of these animals. We believe that all these data contribute to the early detection of possible postoperative complication accurately and timely (e.g., haemorrhagic shock, or sepsis detected by increasing temperature, hypotonia and tachycardia). This may facilitate timely intervention (e.g., introduction of therapeutic antibiotic therapy, fluid substitution, discontinuation of anticoagulation, or sacrifice of the animal to avoid suffering). Besides these "real-time" monitoring aspect, our group is currently focusing on the severity assessment and refinement of animal experiments36,37,38. Retrospective analysis of a large amount of collected telemetry data in these experiments may allow us to better stratify the severity of these kind of surgical interventions and optimize perioperative care (e.g., analgesia) in laboratory animals.
In terms of implantable telemetry, a period of at least 12 days after implantation of the measurement system is recommended to ensure stable and optimal measurement data (based on personal communication). After discussing this issue with various manufacturers providing telemetry solutions for large animals as well as with other research groups using these systems in various experimental settings, we decided to integrate a 14 day period between telemetry implantation and kidney transplantation. During the earlier days, deviations may still occur due to the movement of the animal as the scarring and healing processes are still uncomplete.
Despite its advantages, the above-described model has certain limitations. The complexity and required resources and infrastructure are the most important limitations of the model. The time-consuming experimental protocol, complex techniques, and intense peri-operative follow up necessitate the availability of a significant housing and OR capacity and require the involvement of a larger team, including doctoral fellows, surgeons, veterinary officers, and technicians (Table 1). Therefore, based on our empirical observations, it is usually unfeasible to perform more than two procedures a day. A further disadvantage of the porcine model compared to small animal models is the limited possibility of mechanistic and molecular-biological investigations. In the present protocol only 5-days of follow up was reported. This was suitable to demonstrate the most important experimental characteristics of the model, however, this relatively short follow up may not be sufficient to answer certain specific research question (e.g. long-term recovery of function vs. acute damage). Therefore, a project related extension of the follow up might be necessary. This manuscript describes our current "best-practice" in the experimental setting of porcine orthotopic kidney auto-transplantation. While certain steps are mandatory to successfully establish this model, minor aspects (e.g., the intraoperative use of a bladder catheter, arterial catheter placement to the femoral vs. carotid artery) are facultative and may be avoided/altered at the investigators` discretion. Description and justification of each and every methodical aspect would be beyond the scope of the present protocol and has been discussed elsewhere31. Finally, it is also difficult to replicate the exact clinical situation of ECD KT in the porcine model where elderly donors, allografts with acute kidney injury and donors with multiple co-morbidities and chronic diseases such as hypertension, diabetes mellitus or arteriosclerosis represent a major part of the marginal donor pool8,9.
Notwithstanding the above-mentioned limitations as well as technical and logistical challenges, this well-established and reproducible large animal model of KT provides a unique opportunity to investigate novel therapies and techniques to improve organ preservation and clinical outcomes and represents an excellent platform for younger surgeons to master organ transplantation techniques in a large animal model.
The authors would like to express their gratitude to Pascal Paschenda, Mareike Schulz, Britta Bungardt, Anna Kümmecke for their skillful technical assistance.
The authors declare funding in part from the START program of the Faculty of Medicine, RWTH Aachen University (#23/19 to Z.C.), from the B.Braun Foundation, Melsungen, Germany (BBST-S-17-00240 to Z.C.), the German Research Foundation (Deutsche Forschungsgemeinschaft - DFG; FOR-2591, TO 542/5-1, TO 542/6-1; 2016 to R.T. and SFB/TRR57, SFB/TRR219, BO3755/3-1, BO3755/6-1 to P.B.) and the German Ministry of Education and Research (BMBF: STOP-FSGS-01GM1901A to P.B.), without the involvement of the funders in study design, data collection, data analysis, manuscript preparation or decision to publish.
Name | Company | Catalog Number | Comments |
Anesthesia materials, drugs and medications | |||
Aspirin 500mg i.v., powder for solution for injection | Bayer Vital AG, Leverkusen, Germany | 4324188 | antiplatelet agents |
Atropine sulfate solution for injection, 100mg | Dr. Franz Köhler Chemie GmbH, Bensheim, Germany | 1821288 | parasympatholytic agent, premedication |
Bepanthen ointment for eyes and nose | Bayer Vital AG, Leverkusen, Germany | 1578675 | eye ointment |
BD Discardit II syringes, 2ml, 5ml, 10ml,20ml | Becton Dickinson GmbH, Heidelberg, Germany | 300928, 309050,309110, 300296 | syringes |
BD Micolance 3 (20G yellow) Cannula | Becton Dickinson GmbH, Heidelberg, Germany | 305888 | venous catheter |
BD Venflon Pro Safety (20G pink) | Becton Dickinson GmbH, Heidelberg, Germany | 4491101 | venous catheter |
Buprenorphine (Buprenovet) | Bayer Vital AG, Leverkusen, Germany | 794-996 | analgesia |
Cefuroxime 750mg, powder for preparing injection solution | FRESENIUS KABI Deutschland GmbH, Bad Homburg, Germany | J01DC02 | antibiotics |
Covidien Hi-Contour, Endotracheal Tube 7,5 with Cuffed Murphy Eye | Covidien Deutschland GmbH,Neustadt/Donau, Germany | COV-107-75E | endotracheal Tube |
FENTANYL 0,5 mg Rotexmedica solution for injection | Rotexmedica GmbH Arzneimittelwerk, Trittau, Germany | 4993593 | opioide analgetic agent |
Furosemide-ratiopharm 250 mg/25 ml solution for injection | Ratiopharm GmbH, Ulm, Germany | 1479542 | loop diuretics |
Glucose 5% solution for infusion (500ml, 250ml) | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 3705273,03705422 | infusion fluid |
Glucose 20% solution for infusion | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 4164483 | osmotic diuresis |
Heparin-Sodium 5000 I.E./ml | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 15782698 | anticoagulant |
Isoflurane-Piramal (Isoflurane) | Piramal Critical Care Deutschland GmbH, Hallbergmoos, Germany | 9714675 | volatile anaesthetic agent |
Ketamine (Ketamine hydrochloride) 10% | Medistar Arzneimittelvertrieb GmbH, Ascheberg, Germany | 0004230 | general anaestetic agent |
MIDAZOLAM 15mg/3ml | Rotexmedica GmbH Arzneimittelwerk, Trittau, Germany | 828093 | hybnotica, sedative agent |
NaCl 0,9% solution for infusion (500ml,1000ml) | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 864671.8779 | infusion fluid |
Norepinephrine (Arterenol) | Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany | 16180 | increase in blood pressure |
Organ preservation solution (e.g. HTK) | Dr. Franz Köhler Chemie GmbH, Bensheim, Germany | should be decided based on preference and experimental design | organ preservation |
Pantoprazole 40mg/solution for injection | Laboratorios Normon,Madrid, Spain | 11068 | proton pump inhibitor |
Paveron N 25mg/ml solution for injection (Papaverine Hydrochloride) | LINDEN Arzneimittel-Vertrieb-GmbH, Heuchelheim, Germany | 2748990 | spasmolytic agent for vasodilatation |
Pentobarbital (Narcoren) | Boehringer Ingelheim vetmedica GmbH, Ingelheim, Germany | 1,204,924,565 | used for euthanasia |
Propofol 1% (10mg/ml) MCT Fresenius | FRESENIUS KABI Deutschland GmbH, Bad Homburg, Germany | 654210 | general anaesthetic agent |
Ringer solution | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 1471411 | infusion fluid |
Sterofundin ISO solution for infusion (1000ml) | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 1078961 | Infusion fluid |
Stresnil (Azaperone) 40mg/ml | Elanco | 797-548 | sedative |
Urine catheter ruffle 12CH | Wirutec Rüsch Medical Vertriebs GmbH, Sulzbach, Germany | RÜSCH-180605-12 | transurethral urinecatheter |
Surgical materials | |||
Appose ULC Skin Stapler | Covidien Deutschland GmbH,Neustadt/Donau, Germany | 8886803712 | skin stapler |
Cavafix Certo 375 | B. Braun Deutschland GmbH & Co. KG, Melsungen, Germany | 4153758 | central venous catheter |
EMKA Easytel +L-EPTA Transponder | emka TECHNOLOGIES S.A.S,Paris,France | L-EEEETA 100 | telemetry transponder |
EMKA Reciever and Data Analyzer System | emka TECHNOLOGIES S.A.S,Paris,France | Reviever | telemetry receiver |
Feather Disposable Scapel (11)(21) | Feather, Japan | 8902305.395 | scapel |
Prolene 2-0, blue monofil VISI-BLACK, FS needle | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | EH7038H | skin |
Prolene 3-0,blue monofil,FS1 needle | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | EH7694H | skin |
Prolene 5-0 (simply angulated, C1 needle) blue monofil VISI-BLACK | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | EH7227H | vascular |
Prolene 5-0 (double armed, C1 needle) 60cm | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | KBB5661H | vascular |
Prolene 6-0 (double armed, C1 needle) 60cm | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | EH7228H | vascular |
Sempermed derma PF Surgical Gloves Seril Gr. 7, 7.5, 8 | Semperit investment Asia Pte Ltd, Singapore | 4200782,4200871,4200894 | surgical gloves |
Sentinex® PRO Surgical Gowns Spunlace XL 150cm | Lohmann & Rauscher GmbH & Co. KG, Neuwied, Germany | 19302 | surgical gown |
Tachosil | Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany | MAXI 9,5 x 4,8 cm | haemostasis |
Telasorp Belly wipes (green 45x45cm) | PAUL HARTMANN AG,Heidenheim, Germany | 4542437 | abdominal towel |
Pediatric urine catheter | Uromed Kurt Drews KG, Oststeinbeck, Germany | PZN 03280856 | used for the uretero-cutaneus stoma |
VICRYL- 0 MH Plus | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | V324 | fascial closure |
VICRYL - 3-0, SH1 Plus needle, 75cm | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | W9114 | subcutaneous suture, peritoneal suture, |
VICRYL - 3-0, SH1 Plus needle, 4*45cm | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | V780 | subcutaneous suture, peritoneal suture, |
VICRYL - ligatures Sutupak purple braided, 3-0 | Johnson & Johnson Medical GmbH - Ethicon Deutschland, Norderstedt, Germany | V1215E | threats for ligature |
3M™ Standard Surgical Mask 1810F | 3M Deutschland GmbH, Neuss, Germany | 3M-ID 7000039767 | surgical mask |
Surgical instruments | |||
Anatomical forceps Standard | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | PZ0260 | anatomical forceps |
Atraumatic tweezers steel, De Bakey Tip 1,5mm 8" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF0840 | anatmical atraumatic forceps |
Bipolar forceps 16 cm straight, Branch 0,30 mm pointed, universal fit | Bühler Instrumente Medizintechnik GmbH,Tuttlingen, Germany | 08/0016-A | biopolar forceps |
Bulldog clamp atraumatic,curved, De bakey 78 mm, 3" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF0900 | bulldog clamps |
DE BAKEY-SATINSKY vascular clamp 215mm | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | GF1661 | vascular clamp |
Dissecting scissors Mayo,250 mm, 10" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC2232 | Scissors for dissection |
Dissecting scissors Metzenbaum-Fino, 260 mm, 101/4" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC2290 | Scissors for dissection |
Draeger CATO Anesthetic machine with PM8050 Monitor | Dräger, Drägerwerk AG & Co. KGaA, Lübeck, Germany | 106782 | Ventilation System |
Fine Tweezers, ADSON 180 mm | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | ADSONPZ0571 | fine forceps |
Gosset abdomenal wall spreader | CHIRU-INSTRUMENTE, Kaierstuhl,Germany | 09-621512 | abdominal retractor |
HALSTEAD MOSQUITO,curved, surgical 125mm | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | KL2291 | mosquite clamps |
HF surgical device ICC 300, Electrocautery | Erbe Elektromedizin Gmbh; Tübingen, Germany | 20132-043 | cautery, biopolar |
MICRO HALSTED-MOSQUITO 100mm, curved | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | KL2187 | mosquite clamps |
Micro steel needle holder straight 0,5mm, with spring lock | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | MN1324D | microsurgical needle holder |
Microsurgical/watermaker tweezers LINZ 150mm 6" Ergo round handle | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | MN0087 | fine microsurgical forceps |
needle holder Mayo-hegar,190 mm, 71/2" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | NH1255 | needle holder |
Overhold Slimline Fig. 0 8 1/2" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | KL4400 | overholds |
Sterile Gauze 10X10 | Paul HaRTMANN AG,Heidenheim, Germany | 401725 | sterile gauze |
Suction tip OP-Flex Handpiece Yankauer | Pfm Medical AG, Köln, Germany | 33032182 | suction |
surgical forceps Standard 5 3/4" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | PZ1260 | surgical forceps |
surgical scissors standard pointed-blunt (thread/cloth scissors)175 mm, 7" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC1522 | surgical Scissors |
Titanit vascular scissors POTTS-SMITH,185 mm, 71/4"60° | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | SC8562 | Pott scissors |
Tunneling instrument | Marina Medical Instruments Inc,Davies,US | MM-TUN06025 | subcutaneous tunneling |
Vessel loops | Medline International Germany GmbH,Kleve, Germany | VLMINB | hold and adjust the vessel |
Wound spreaders Weitlander, Stump,110 mm, 41/4" | ASANUS Medizintechnik GmbH, Tuttlingen, Germany | WH5210 | wound care |
Further material | |||
Heating pad | Eickemeyer - Medizintechnik für Tierärzte KG, Tuttlingen, Germany | 648050 MHP-E1220 | maintain body temperature during surgery |
Laryngoscope, customized | Wittex GmbH, Simbach, Germany | 333222230 | expose the vocal cord |
Rectal temperature probe | Asmuth Medizintechnik, Minden, Germany | ASD-RA4 | measure body temperature |
Spray wound film | Mepro-Dr. Jaeger und Bergmann GmbH, Vechta, Germany | 2830 | keep sterile condition |
Sterile organ bag | Raguse Gesellschaft für medizinische Produkte, Ascheberg, Germany | 800059 | organ preservation |
swine jacket small, adult Landrasse swine 30-50kg, customized for Emka Telemetry and urinary catheterization | Lomir Biomedical Inc., United Kingdom | SS J1LAPMP | swine jackets to pretect implanted catheters and store urine bag |
Ultrasound device, Sonosite Edge-II | FUJIFILM SonoSite GmbH, Frankfurt, Germany | V21822 | ultrasound and color Doppler |
Urine bag 2000ml Volume | ASID BONZ GmbH, Herrenberg, Germany | 2062578 | disposable urine bag connected to the uretero-cutaneous fistula catheter |
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