Transperitoneal laparoscopic nephrectomy for giant polycystic kidneys: A case control study

Objectives. To describe the technique and compare the surgical outcomes of patients with autosomal dominant polycystic kidney disease (ADPKD) undergoi ng laparoscopic or open nephrectomy for giant kidneys. Methods. The surgical outcome of our first 10 consecutive patients with ADP KD who underwent laparoscopic nephrectomy was analyzed from a large prospec tive computer database. The results were compared with the 10 most recent o pen nephrectomy procedures performed for ADPKD at the same institution. To facilitate safe laparoscopic hilar dissection, the kidneys were made manage able by volume reduction, accomplished through diligent cyst puncture and a spiration using a novel prototype suction device with a beveled tip. Results. No statistically significant differences were found between the la paroscopic and open surgical groups relative to patient sex, age, or median preoperative kidney size (24.0 versus 21.5 cm, respectively). The laparosc opic patients were significantly heavier than their open counterparts (94 v ersus 78 kg, P = 0.0095) and had a longer operative time (247 versus 205 mi nutes, P = 0.04). One conversion to open surgery occurred in the laparoscop ic group because cysts were adherent to the spleen and colonic mesentery. N o intraoperative complications or deaths occurred in either group and the p ostoperative complications were similar. The mean length of the postoperati ve hospitalization was markedly reduced with the laparoscopic compared with the open approach (2.6 versus 6.6 days, P = 0.00002). At a median of 12 mo nths after surgery, none of the laparoscopic patients had recurrent pain, b leeding, or infection. Conclusions. Laparoscopic nephrectomy is technically safe and feasible in p atients with ADPKD. Progressive cyst aspiration is a critical step, facilit ating the identification of vital structures and the creation of enough abd ominal cavity space to operate. The advantages of this minimally invasive t echnique include a short hospital stay, minimal pain, low morbidity, and su perior cosmesis. UROLOGY 58: 23-27, 2001. (C) 2001, Elsevier Science Inc.