Splenorenal bypass is a major surgical procedure that's used for the management of renal artery stenosis. Herein, we evaluate the feasibility and efficacy of performing laparoscopic splenorenal bypass in a chronic canine model.

A total of 12 animals were used for this study. The initial 6 acute animals were used to develop the technique. The remaining 6 surviving animals, which form the basis for this report, were used for a chronic study with up to 2 months follow-up. The renal artery and the distal splenic artery was dissected, its proximal end clamped and its distal end cut and spatulated. An end-to-end anastomosis of the splenic artery and renal artery was performed using only laparoscopic freehand suturing and knot-tying techniques. Upon revascularization, a laparoscopic doppler ultrasound probe was used to document blood flow in the renal artery. Three animals were each followed for 1 month and 2 months, respectively.

The total operative time was 297±36 min. The mean number of suture bites per anastomosis was 14.3. The only intraoperative complication was hemorrhage from the anastomotic site. Intraoperative Doppler ultrasound documented good blood flow in all 6 animals upon releasing the clamp. At the time of euthanasia, intravenous pyelography (IVP) showed early visualization of the left kidney with prompt drainage in 5 of the 6 surviving animals. In one animal that had two left renal arteries, a distal thrombosis was found despite the patent anastomotic site.

Laparoscopic splenorenal bypass can be performed in a reproducible fashion with using only intracorporeal techniques. We believe that with experience, complex urologic vascular procedures can be laparoscopically performed in the future.