Begin by preparing for the surgery. To perform retroperitoneal dissection, incise the peritoneum to the right of the midline from the level of the right kidney to the aortic bifurcation using electrocautery. Sharply expose the right kidney, right renal vein, right renal artery, and inferior vena cava, as well as the aorta.
Using a large vessel loop, obtain circumferential control of the distal infrarenal aorta. Then, obtain circumferential control of the mid infrarenal IVC. And ligate the IVC using a 2-0 silk tie.
Next, obtain circumferential control of the right and left renal arteries and veins. Ligate these structures using 2-0 silk ties. Proceed with intrathoracic dissection by retracting the liver inferiorly to expose the right hemidiaphragm.
Apply two Allis clamps to the membranous portion of the right hemidiaphragm, and incise the diaphragm in between the two clamps using electrocautery. Extend the diaphragm myotome horizontally to approximately seven centimeters. Next, obtain circumferential control of the intrathoracic IVC.
Place a 2-0 silk tie around the intrathoracic IVC and snap the ends of the suture with a small hemostat without occluding the IVC. Then, use two Allis clamps to retract the edge of the diaphragmotomy inferiorly. And extend it to the left hemidiaphragm.
Administer systemic heparin to the pig for anticoagulation via peripheral venous access, and wait for at least three minutes before proceeding. Using an 18-gauge micropuncture needle, access the infrarenal aorta. Then, pass a J wire through the needle into the aorta and remove the needle over the wire.
Place a 10 French sheath over the wire into the aorta and remove the wire. Next, connect IV tubing to the 10 French sheath, and infuse sterile UW solution through the sheath at a rate of 40 to 60 drops per minute in a sterile fashion. Then, using an aortic clamp, clamp the infrarenal aorta and the descending thoracic aorta.
Tie the intrathoracic IVC with the previously placed 2-0 tie, and administer potassium chloride via peripheral venous access for euthanasia. Then, isolate the pancreatic duct by locating it at the entry of the duodenum. Ligate the duct using two 3-0 silk ties and transect the duct between the ties.
Complete the pancreatectomy. To infuse the pancreas with the enzyme solution, pass 60-milliliter boluses into the pancreatic duct until the entire enzyme solution is infused. Placed the pancreas in the Ricordi chamber along with the mesh filter and rubber gasket.
And secure the lid onto the Ricordi chamber to seal it. Then, place the heating coil in a hot water bath set to 47 degrees Celsius. Insert the inflow and outflow cannulas into the digestion circuit reservoir containing 500 milliliters of 1X HBSS.
Initiate the pump at a flow rate of 450 milliliters per minute until the entire chamber is filled with the digestion solution. Then, decrease the flow rate to 100 milliliters per minute as the fluid circulates within the circuit.
