Laparoscopic cyst decortication using the harmonic scalpel for symptomaticautosomal dominant polycystic kidney disease

Background: Management of acute and chronic pain in patients with autosomal dominant polycystic kidney disease (ADPKD) has, until recently, been limit ed to oral narcotic regimens, percutaneous drainage, open decortication, or nephrectomy. Patients and Methods: Five women and two men with a mean age of 44 (range 2 0-55) years underwent laparoscopic cyst decortication with the Harmonic Sca lpel. All patients had end-stage renal disease secondary to ADPKD and pain attributed to their cyst disease. Two patients had simultaneous bilateral, one had staged bilateral, and remaining four patients had unilateral decort ication. The mean follow-up was 14 months (range 2-29 months). Preoperative and postoperative pain was assessed using a standardized scale. Results: There were no intraoperative complication, and visible cysts were decorticated in a total of 10 renal units. There was a significant reductio n in the pain scale, from a mean of 7.4/10 preoperatively to 2.3/10 on foll ow-up for the entire group (P < 0.0001). One patient reported recurrence of pain at 4 months, and bilateral nephrectomy was performed. Major complicat ions included postoperative bleeding in two patients and readmission for il eus in one. Conclusion: Laparoscopic decortication of painful renal cysts in ADPKD pati ents is a feasible procedure for symptomatic relief. The Harmonic Scalpel i s a useful tool; however, it may not be adequate in preventing delayed blee ding.