Multiple refinements to the anaesthetic protocol for laparoscopic orthotopic kidney auto-transplantation in a pig model

Fifty-four pigs (Sus scrofa, Large White cross) from a commercial pig farm were anaesthetised over a six-year period from October 2011. The procedural stages included initial instrumentation for intra-operative monitoring, laparoscopic nephrectomy, preparation of the kidney graft, orthotopic auto-transplantation by either a laparoscopic approach or an open surgical approach, and ligation of the contralateral ureter. During the evolution and establishment of this pig model multiple refinements were introduced: (1) a heat pad was changed to a circulating warm air blanket; (2) routine administration of anticholinesterase and antimuscarinic drugs for reversal of neuromuscular blockade; (3) a technique for urethral catheterisation was developed; (4) ultrasound guidance for placement of a central venous line was learned; (5) intravenous infusions of morphine and ketamine were instituted for a more stable and balanced anaesthetic protocol; and (6) post-operative monitoring was performed by two technical staff for at least the first six hours after extubation of the trachea. The combination of refinements to the anaesthesia protocol for laparoscopic orthotopic kidney auto-transplantation over the first 54 pigs has translated to improved outcomes. This conclusion is entirely subjective as accurate measurement of the impact of each refinement is impossible. Nevertheless, refinement is a continuous process and should be applied to the entire range of procedures involved in animal use for scientific purposes.