Laparoscopic Nephrectomy with Intact Specimen Extraction for Polycystic Kidney Disease

Binsaleh, Saleh; Al-Enezi, Ahmed; Dong, Jihao; Kapoor, Anil

doi:10.1089/end.2007.0147

Cited by 17 publications

(22 citation statements)

References 12 publications

(13 reference statements)

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“…The laparoscopic approach for pre-transplant nephrectomy for ADPKD has potential benefits, including shorter hospital stay, decreased analgesia requirements, and minimal blood loss. [5][6][7] This case highlights the challenges of operating on a horseshoe kidney. On top of the lack of a familiar orientation and location, horseshoe kidneys are joined by a fibrous isthmus in the midline and are frequently supplied by aberrant and numerous vessels.…”

Section: Discussionmentioning

confidence: 94%

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Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

Dason

Allard

Shayegan

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(11-12):e881-3. http://dx.doi.org/10.5489/cuaj.1919 Published online November 24, 2014. AbstractA 45-year-old female patient with autosomal dominant polycystic kidney disease (ADPKD) and a horseshoe kidney underwent right laparoscopic nephrectomy. The indication for nephrectomy was to create space within the right iliac fossa for renal transplantation. The operation proceeded as routine for laparoscopic nephrectomy for ADPKD, but was uniquely challenging due to the large size and extensive vasculature of the polycystic horseshoe kidney. In addition to documenting the feasibility of the pure laparoscopic approach for nephrectomy in patients with ADPKD and horseshoe kidney, this case highlights the abnormal location and vasculature encountered when operating on horseshoe kidneys.

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Section: Discussionmentioning

confidence: 94%

“…4 Laparoscopic nephrectomy in ADPKD is technically challenging due to renal size, but has benefits that include low morbidity, short hospital stay, and a fast recovery. 5 We present the first reported case of a unilateral pre-transplant pure laparoscopic nephrectomy performed for a polycystic horseshoe kidney.…”

Section: Introductionmentioning

confidence: 98%

Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

Dason

Allard

Shayegan

et al. 2014

CUAJ

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“…12 Since the description of laparoscopic nephrectomy in ADPKD by Elashry and colleagues, many centres have described their experience with pure laparoscopic or hand-assisted laparoscopic nephrectomy for ADPKD. [7][8][9][13][14][15][16] Binsaleh and colleagues compared laparoscopic and open approaches and concluded that laparoscopic nephrectomy is a feasible and safe alternative to open nephrectomy in patients with ADPKD. They also showed laparoscopy resulted in shorter incision, less pain, shorter length of stay and excellent cosmesis as compared to open nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 The patient is placed in the lateral decubitus position and the operative table is flexed to open the costophrenic angle.…”

Section: Laparoscopic Nephrectomy For Adpkdmentioning

confidence: 99%

“…5 Since the first description of laparoscopic nephrectomy for polycystic kidney in ADPKD by Elashry and colleagues, which decreased the morbidity of open nephrectomy, 6 we and several other authors have reported their experience of laparoscopic nephrectomy for unilateral or bilateral polycystic kidneys. [7][8][9] We hereby describe our updated technique and outcome of laparoscopic nephrectomy for massive polycystic kidneys.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic nephrectomy for massive polycystic kidney disease: Updated technique and outcomes

Bansal¹,

Kapoor

2014

CUAJ

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Introduction: 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. Methods: 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). Results: 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). Conclusions: 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.

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Nephrectomy in patients with autosomal dominant polycystic kidney disease, does size matter?

2016

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because of a shorter duration of hospitalization, less blood loss, and improvement in cosmetic aspects [4]. Despite these results, we are doubtful whether these techniques can be easily performed in the general ADPKD population.The main indication to perform nephrectomy in ADPKD patients is that there is not enough abdominal space to allow kidney transplantation [5]. Benoit and coworkers briefly mentioned that kidney weight and volume were not collected in their study [3]. To our knowledge, of the six other studies that have compared a laparoscopic with an open approach for nephrectomy in ADPKD, none collected data on pre-operative kidney volume and only four examined kidney weight post-operatively [4]. In addition, none of these studies described clearly what the eligibility criteria were with respect to pre-operative kidney volume for choosing the various approaches that were investigated. In these studies, mean weight of the removed kidney varied between studies from 966 to 1507 g [6-9]. Data from our center show that, in 20 ADPKD patients who underwent nephrectomy (17 for transplant preparation, 2 for mechanical complaints, and 1 for cyst infection), the median weight and volume of the removed kidney was 2875 (95 % CI 1880-4943) g and 2.83 (95 % CI 1.68-5.49) L, respectively. Only in four cases was the procedure performed by a laparoscopic approach and the remaining 16 by an open approach. In these latter cases, the treating urologist considered, because of the size of the native kidney, that a laparoscopic approach was not feasible. The fact that in the literature the mean weight of the removed kidney is considerably lower than in our experience, and also low when considering that removal of a large polycystic kidney to allow a renal transplant is the most frequent reason for a nephrectomy in ADPKD, suggests that selection bias is likely in these studies. It seems that ADPKD patients with Dear Editor,

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Laparoscopic Nephrectomy with Intact Specimen Extraction for Polycystic Kidney Disease

Abstract: 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.

Cited by 17 publications

References 12 publications

Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

Pure laparoscopic unilateral nephrectomy for a patient with a polycystic horseshoe kidney

Laparoscopic nephrectomy for massive polycystic kidney disease: Updated technique and outcomes

Nephrectomy in patients with autosomal dominant polycystic kidney disease, does size matter?

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