Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique.

Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
The Canadian Journal of Urology (Impact Factor: 0.91). 01/2007; 13(6):3340-5.
Source: PubMed

ABSTRACT Autosomal dominant polycystic kidney disease an inherited systemic disorder is characterized by the development of multiple cysts in the kidneys and other organs. When nephrectomy is indicated, the laparoscopic approach is challenging due to the massive size of these kidneys. We present our technique and evaluate the surgical outcomes of laparoscopic versus open nephrectomy for patients with such condition.
A retrospective review was done for six laparoscopic and six open nephrectomies performed by two laparoscopic surgeons in two university hospitals between January 2004 and December 2004. Preoperative, intraoperative, and postoperative data are presented. A standard subcostal incision was used for the open cases while for the laparoscopic approach a 3-4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which is then removed intact or morcellated through pfannenstiel, midline, or expanded port site incision.
The laparoscopic patients had a longer operative time with one major complication compared to the open group. On the other hand laparoscopic group achieved minimal blood loss, less narcotic requirement and a shorter hospital stay. No conversion to open required in the laparoscopy group. At a median follow up of 1 year no long-term complications reported in either groups.
Laparoscopic nephrectomy for polycystic kidney disease is a feasible and safe alternative to open approach. In addition to low morbidity, other advantages of laparoscopic surgery also achieved in this subset of patients such as the ability to remove the dissected kidney through a small incision, reduced postoperative pain, short hospital stay, and excellent cosmesis.

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    ABSTRACT: Context: Indications for laparoscopic renal surgery are increasing; however benefits in adult polycystic kidney disease (APKD) remain uncertain. Objective: To systematically synthesise the reported literature on safety, feasibility, complications and early outcomes of laparoscopic nephrectomy in APKD to determine clinical benefits for surgical practice. Evidence Acquisition: We conducted a meta-analysis of the published literature reporting on laparoscopic nephrectomy in APKD between 1991 and 2013. The criteria from the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) study were used to assess the quality of reported literature. Results: One prospective and fifteen retrospective studies of low to modest quality (according to the STROBE checklist) were identified, reporting on 293 patients who underwent laparoscopic nephrectomy for APKD. None of the studies was a randomized clinical trial (RCT). Transperitoneal approach was the most commonly used technique. Body mass index ranged from 16 to 57; mean 26.2kg/m2. 53% of patients were dialysis dependent and 31% had a prior or simultaneous transplant. Kidney length ranged from 8 to 50cm (mean 34.5cm), and the mean mass of affected kidneys was 1,647g (range 132g - 7,200g). Duration of hospital stay ranged from 2.6 to 11 days; mean 4.9 days. Operative time ranged from 90-568 minutes, with 16.2% of patients requiring blood transfusion. There were 24 intra-operative complications and 68 post-operative complications, a rate of 8% and 24% respectively. A total of 16 cases (5%) were converted to open technique. No mortality was reported in any of the included studies. Conclusion: The quality of the included studies is poor, and it is difficult to argue for or against change in clinical practice as the evidence included is of level 3 and 4 only. Higher quality studies are needed to demonstrate that the technique is generalizable across all populations.
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    ABSTRACT: We present our technique of laparoscopic nephrectomy for massive polycystic kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and review the outcome analysis of our experience. We retrospectively reviewed all transperitoneal laparoscopic nephrectomies done for polycystic kidneys at a university hospital. Our technique included three 12-mm ports with additional one or two 5-mm ports, with usage of retraction devices, such as the Jarit PEER retractor (J. Jamner Surgical Instruments, Inc, Hawthorne, NY). In total, 39 (left 14, right 25) laparoscopic nephrectomies were performed in 32 patients (male 21, female 11). Surgical indications were varied: to create space for future renal transplant in 21 (54%), to alleviate pain in 16 (41%), to prevent recurrent urosepsis in 2 (5%), to prevent recurrent bleeding which would require transfusions in 2 (5%) and to remove a renal tumour in 1 kidney (2.5%). Four patients had surgery for more than one reason. The mean age and body mass index were 52.2 years (range: 29-72) and 26.9 kg/m(2) (range: 21.6-34.0), respectively. The mean preoperative hemoglobin and serum creatinine levels were 131.6 g/L (range: 107-171) and 514 µmol/L (range: 84-923), respectively; 26 (81%) patients were on dialysis. The mean operative time and estimated blood loss were 185 minutes (range: 113-287) and 94 mL (range: 10-350), respectively. No patient required open conversion. The mean specimen size was 24.2 cm (range: 15-38); weight 1515 g (range: 412-4590) and the length of extraction incision was 9.2 cm (range: 6-13). There were 1 Grade 2 2 (2.5%), 2 Grade 3b (5%) and 1 Grade 4a-d (2.5%) complications. The mean length of stay was 4.5 days (range: 3-8). Our technique of laparoscopic nephrectomy for massively enlarged polycystic kidneys in ADPKD is safe and offers all the advantages of minimal access surgery, such as smaller incision, decreased estimated blood loss, excellent cosmesis and faster recovery.
    Canadian Urological Association journal = Journal de l'Association des urologues du Canada 10/2014; 8(9-10):341-345. DOI:10.5489/cuaj.2097 · 1.92 Impact Factor
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    ABSTRACT: To evaluate the feasibility and morbidity of laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPK).

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