Laparoscopic bilateral synchronous nephrectomy for autosomal dominant polycystic kidney disease: The initial experience

Purpose: We report our experience with laparoscopic bilateral synchronous n ephrectomy for giant symptomatic autosomal dominant polycystic kidney disea se (ADPKD) and compare outcome data with open bilateral nephrectomy. Materials and Methods: Since March 1998, 10 patients underwent bilateral sy nchronous laparoscopic nephrectomy for giant symptomatic ADPKD. A 3 port re troperitoneal laparoscopic approach was used to secure the renal hilum and mobilize the kidney. Intact specimen extraction was performed through a mid line infraumbilical extraperitoneal incision. The patient was then repositi oned for the contralateral retroperitoneoscopic nephrectomy, with the secon d specimen also delivered through the same infraumbilical incision. Data we re retrospectively compared with 10 patients who had undergone bilateral sy nchronous open nephrectomy for ADPKD between 1981 and 1992. Results: Patients in the laparoscopic and open groups were comparable in re gard to age (53 versus 47 years, p = 0.54) and Anesthesiologist Society of America class (3 versus 3, p = 0.84) but patients in the laparoscopic group were significantly more obese (body mass index 35.9 versus 23.8, p = 0.02) . For comparable total specimen weights (3 versus 3 kg, p = 0.69) surgical time was longer in the laparoscopic group (4.4 versus 3.8 hours, p = 0.007) . However, the laparoscopic group was superior in regard to blood loss (150 versus 325 cc, p = 0.05), postoperative requirement of nasogastric tube (1 0% versus 100%, p = 0.0001), narcotic analgesics (34.2 versus 120.4 mg. mor phine sulfate equivalent, p = 0.03) and hospital stay (1.5 versus 9 days, p = 0.004). Complications occurred in 5 patients (50%) in the laparoscopic g roup and 4 (40%) in the open group (p = 0.66). No laparoscopic case was con verted to open surgery. Conclusions: Synchronous bilateral retroperitoneal laparoscopic nephrectomy for giant symptomatic adult polycystic kidney disease is feasible, safe an d efficacious, and can be performed either before or after renal transplant ation. Compared to open surgery, the laparoscopic approach results in signi ficantly shorter hospital stay, decreased morbidity and quicker recovery. L aparoscopy is currently our technique of choice in this setting.