Laparoscopic nephrectomy with intact specimen extraction for polycystic kidney disease.

PURPOSE

We present our technique and evaluate the experience of laparoscopic nephrectomy with intact specimen extraction for patients with autosomal dominant polycystic kidney disease (ADPKD).

MATERIALS AND METHODS

We retrospectively reviewed 16 laparoscopic nephrectomies performed by one laparoscopic surgeon in a university hospital between April 2004 and March 2006. Preoperative, intraoperative, and postoperative follow-up data are presented. A 3- to 4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which was then removed intact through a Pfannenstiel or infraumbilical midline incision.

RESULTS

A total of 16 patients were included in this study over a 2-year period. The average patient age was 49 years (range 29-67 years), and the average body mass index was 26.9 kg/m(2) (range 19.1-38.3 kg/m(2)). Eleven (69%) patients were receiving dialysis. The mean preoperative creatinine level was 520 mumol/L (range 108-976 mumol/L). Ten right (63%) and six left (37%) nephrectomies were performed. No patient had preoperative embolization. The mean operative time was 167 minutes (range 95-233 min). The mean blood loss was 76 mL (range 10-200 mL). No patient received a blood transfusion. The mean kidney pathologic size was 23 cm (range 16-35 cm), while the mean extraction size was 10.4 cm (range 8-12 cm). There were no deaths. There was one intraoperative complication (6.25%) and three postoperative ones (19%). No procedure was converted to an open approach. The mean length of hospital stay was 4 days (range 2-11 d).

CONCLUSIONS

Laparoscopic nephrectomy for ADPKD is technically feasible and clinically safe. In addition to its low morbidity, other advantages of laparoscopic surgery are the ability to remove the dissected kidney through a small incision, short hospital stay, excellent cosmesis, and fast recovery.