Robotic Bilateral Nephrectomy for Large Polycystic Kidney Disease

Abstract

Objective To describe our technique and review our experience with synchronous robotic bilateral nephrectomy for large kidneys in ADPKD with the Da Vinci XI and Da Vinci Single Port platforms (Intuitive Surgical, Sunnyvale, CA). Materials and Methods We performed a retrospective review of all robotic bilateral nephrectomy cases from January 2020 to October 2021 at a high-volume robotic single center. Demographic data and perioperative details including preoperative CT scans, indication for nephrectomy, and renal function were collected. We also collected post-op course data and final specimen data details. Results Eleven cases were included. Patient demographics, indications for surgery, and specimen data are outlined in table 1. The largest kidney removed measured 32 cm in largest dimension on preoperative imaging. Median operating time from incision to closure was 299 minutes (IQR 260, 339). Median estimated blood loss was 100cc (IQR 50, 175). Two patients were transfused intraoperatively. Median pre- and post-operative Hgb was 11.3 and 9.7 respectively. Median length of stay was 3 days (IQR 2, 3.5). There were no intraoperative complications and no open conversions. Post-operative complications included one incisional hematoma, and one superficial wound infection. One patient was admitted to the surgical ICU post operatively for ventilatory support. Two patients were readmitted within 30 days of surgery. Conclusion The robotic approach to bilateral native nephrectomy for ADPKD should be considered when native nephrectomies are indicated. The operative times and outcomes compare favorably to prior series and this technique works even for very large kidneys.