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nique is then utilized (Fig. 6.7). The transplant incision is reopened. Dissection is conducted through the fascia to the kidney capsule, avoiding entering the peritoneum. The capsule is opened and the renal parenchyma dissected from it circumferentially. The kidney is shelled out of the capsule. No attempt is made to identify the individual artery, vein, or ureter. Dissection is carried out to the hi-lum. A large vascular clamp is then placed upon the hilum with extreme caution to avoid occluding the iliac vessels. Confirmation that the iliac artery is opened is made by palpation of the femoral pulse. With a large vascular clamp on the hilum the broad pedicle is sharply divided and oversewn. The small amount of remaining foreign tissue left behind is not problematic. The space occupied by the kidney is obliterated by pressure from the intraperitoneal organs. Occasionally closed suction drainage is placed in the wound. Transplant nephrectomy is a shorter procedure than a kidney transplant, and the convalescence is typically a two day inpatient stay.

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