Limitations of Laparoscopy for Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

Michael C. Lipke, Vladislav Bargman, Martin Milgrom, Chandru P. Sundaram

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Purpose: We retrospectively studied outcomes following bilateral hand assisted laparoscopic nephrectomy. Materials and Methods: We retrospectively reviewed the charts of 18 patients with symptomatic autosomal dominant polycystic kidney disease who underwent bilateral hand assisted laparoscopic nephrectomy. Preoperative radiographic imaging was reviewed retrospectively to determine kidney size based on an ellipsoid shape. A visual analog pain scale with scores of 0 to 10 to assess pain related to autosomal dominant polycystic kidney disease was measured preoperatively and postoperatively. Results: Average patient age was 48.2 years (range 30 to 64). Of the patients 14 successfully underwent bilateral hand assisted laparoscopic nephrectomy, while 4 required open conversion. A total of 16 patients underwent nephrectomy for pain and 2 underwent surgery for frequent recurrent symptomatic urinary tract infections. All patients except 1 underwent renal transplantation before bilateral nephrectomy. There was a significant difference in the volume of the right and left kidneys between the hand assisted laparoscopic and open groups (mean ± SD 1,043 ± 672 and 1,058 ± 603.8 vs 4,052 ± 548 and 3,592 ± 1,752 cm3, p <0.001 and 0.06 respectively). There were 5 complications, including wound infection and protracted ileus in 2 patients each, and incisional hernia in 1. In addition, the difference in mean preoperative and postoperative visual analog pain scores was statistically significant (6.9, range 3 to 10 and 0.5, range 0 to 2, p <0.05). Conclusions: Bilateral laparoscopic hand assisted nephrectomy is a safe and reliable option in patients requiring removal of the 2 kidneys in a single setting. Rather than performing staged nephrectomies, hand assisted laparoscopic nephrectomy allows the single administration of general anesthesia and provides effective relief of bothersome symptoms in patients with symptomatic autosomal dominant polycystic kidney disease. This procedure is safe in patients with renal transplants. Patients with massive polycystic kidneys with a kidney volume of greater than 3,500 cc are at increased risk for open conversion and they may have improved outcomes if open nephrectomy is attempted from the outset.

Original languageEnglish (US)
Pages (from-to)627-631
Number of pages5
JournalJournal of Urology
Volume177
Issue number2
DOIs
StatePublished - Feb 1 2007
Externally publishedYes

Keywords

  • kidney
  • kidney transplantation
  • laparoscopy
  • nephrectomy
  • polycystic kidney diseases

ASJC Scopus subject areas

  • Urology

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