Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease

Asimakopoulos, Anastasios D.; Gaston, R.; Miano, Roberto; Annino, Filippo; Mugnier, Camille; Dutto, Lorenzo; Vespasiani, Giuseppe; Spera, Enrico; Hoepffner, Jean-Luc; Piéchaud, Thierry

doi:10.1007/s00464-014-3663-y

Cited by 11 publications

(6 citation statements)

References 28 publications

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“…All 16 studies were retrospective analyses of an exclusively ADPKD cohort, and utilised histological examination of native nephrectomy specimens to assess for the presence of RCC [6, 10, 11, 16‒28]. Studies were published between 1987 and 2022 and examined nephrectomy specimens from 1,147 ADPKD patients.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis

Drake,

Paynter,

Yim

et al. 2024

Nephron

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Background: Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited condition; however, its relationship with renal cell carcinoma (RCC) remains unclear. This paper aims to establish the prevalence of RCC and its subtypes amongst ADPKD patients. Methods: A database search was conducted to retrieve studies reporting RCC occurrence within ADPKD patients until July 2023. Key outcomes included number and subtype of RCC cases, and number of RCCs presenting incidentally. A random-effects meta-analysis was performed. Results: Our search yielded 569 articles, 16 met the inclusion criteria. Nephrectomy specimens from 1,147 ADPKD patients were identified. Of studies reporting per-kidney results (n = 13), 73 RCCs were detected amongst 1,493 kidneys, equating to a per-kidney prevalence of 4.3% (95% CI, 3.1–5.7, I2 = 15.7%). 75 ADPKD patients were found to have RCC (75/1,147), resulting in a per-person prevalence of 5.7% (95% CI, 3.7–7.9, I2 = 40.3%) (n = 16). As 7 patients had bilateral disease, 82 RCCs were detected in total. Of these, 39 were clear cell RCC, 35 were papillary and 8 were other. As such, papillary RCCs made up 41.1% (95% CI, 25.9–56.9, I2 = 18.1%) of detected cancers. The majority of RCCs were detected incidentally (72.5% [95% CI, 43.7–95.1, I2 = 66.9%]). Conclusion: ADPKD appears to be associated with the papillary RCC subtype. The clinical implications of these findings are unclear, however, may become apparent as outcomes and life expectancy amongst APDKD patients improve.

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Section: Resultsmentioning

confidence: 99%

“…As such, 82 RCCs were detected in total. Thirteen papers stated the total number of kidneys analysed, reporting 73 RCCs amongst 1,493 kidneys [6, 10, 11, 16, 17, 21‒28]. Following meta-analysis, the per-kidney prevalence was 4.3% (95% CI, 3.1–5.7, I 2 = 15.7%) (shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis

Drake,

Paynter,

Yim

et al. 2024

Nephron

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“…We do not consider it a good option to section the kidney or open the cysts while in the peritoneal cavity, due to their often infected content, which can potentially cause prolonged postoperative ileus or peritonitis-like syndrome. 27 Although the incidence of neoplasms on polycystic kidneys is the same as that in the general population, 28 we do not consider it correct to perform the morcellation of the surgical specimen as suggested by some authors 29 due to the risk, albeit low, of neoplastic dissemination and However, in the case of massive polycystic kidneys, the need for a large final incision to extract the intact specimen compromises the aesthetic result. In these cases it is preferable, in our opinion, to proceed immediately with such an incision and use a hand-port for the hand-assisted procedure (HALN).…”

Section: Discussionmentioning

confidence: 97%

Laparoscopic Nephrectomy for Massive Kidneys in Polycystic Kidney Disease

Collini

Benigni

Ruggieri

et al. 2021

JSLS

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Background and Objectives: Laparoscopic nephrectomy is now considered a feasible surgical approach, even for large kidneys. In the case of massive kidneys, laparoscopy can be problematic, so that some authors suggest an open approach. However, previous studies have shown that hand-assisted laparoscopic nephrectomy (HALN) may represent a useful compromise.We describe our hand-assisted laparoscopic technique for nephrectomy of large kidneys (> 2500 g) to encourage the use of laparoscopy for nephrectomy in autosomal dominant polycystic kidney disease.Methods: We retrospectively analyzed data from 26 nephrectomies in 17 patients who underwent HALN for ADPKD and compared them to a group of 22 nephrectomies in 18 patients with open surgical technique.Results: The duration of the procedure was significantly longer in the laparoscopic group, with a median of 180 minutes versus 90 minutes for the unilateral nephrectomies, and 240 minutes versus 122 minutes for the bilateral procedures. The median kidney weight in the open group was 2500 g (range 1300 -4500 g), while the median weight in the HALN group was 2375 g (range 1000 -4700 g). The median hospital stay was comparable. No significant differences were recorded in the intra-and postoperative complication rate. Conclusion:Hand-assisted laparoscopic nephrectomy can be considered a technique of choice for patients suffering from ADPKD requiring nephrectomy, also with massive kidneys weighing more than 3500 g. Compared to open nephrectomy, HALN can be performed safely, with reasonably longer operating times and without major complications, and offers a significant reduction in hospitalization time, pain and postoperative discomfort.

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“…The laparoscopic morcellator is a device that is not familiar to urologists; however, the application of this equipment has recently been reported in some urologic diseases. Asimakopoulos et al [20] reported on tissue retrieval performed using a laparoscopic morcellator in a case series of huge laparoscopic autosomal-dominant polycystic nephrectomies. However, this study was the first attempt to report tissue removal with a laparoscopic morcellator using a PNV.…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique of Morcellation Using a Pneumovesicum After Holmium Laser Enucleation of the Prostate in Complicated Situations: Our Initial Experience and Tips

et al. 2019

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Purpose To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum (PNV) after Holmium laser enucleation of the prostate (HoLEP). Methods From January 2016 to April 2018, a total of 93 consecutive patients treated with HoLEP were enrolled in this study. For tissue morcellation, we used the PNV morcellation technique for an initial series of 21 patients and the conventional technique (Lumenis VersaCut) for a consecutive series of 72 patients. We compared efficiency and safety between the novel technique and the traditional technique. Subgroup analysis was performed to assess the effectiveness of the current technique in the large prostate (>70 mL). Results There were significant differences in mean age and prostate volume between the 2 groups. However, there were no significant differences in the baseline characteristics and preoperative parameters in the subgroup analysis of large prostates (>70 mL). The mean morcellation efficiency was higher (8.50±1.94 minutes vs. 1.76±0.45 minutes, P<0.05) and the time of morcellation (7.81±1.25 minutes vs. 34.04±11.14 minutes, P<0.05) was shorter in the PNV group. Moreover, there were no significant differences between groups in hospitalization period (2.62±1.10 days vs. 2.90±1.26 days, P=0.852) and any other postoperative events, including recatheterization, reoperation, clot retention, and urethral stricture (P-value range, 0.194–0.447). In the PNV group, there were some cases of procedure-related complications, including postoperative extravesical leakage (5th case), clot retention (8th case), and recatheterization (9th case). Conclusions This method has a higher tissue retrieval efficacy, with the advantage of excellent visibility compared to conventional morcellation. The current method can be applied when a transurethral morcellator is out of order or cannot be used.

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Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease

Cited by 11 publications

References 28 publications

Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis

Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis

Laparoscopic Nephrectomy for Massive Kidneys in Polycystic Kidney Disease

A Novel Technique of Morcellation Using a Pneumovesicum After Holmium Laser Enucleation of the Prostate in Complicated Situations: Our Initial Experience and Tips

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