Bilateral hand-assisted laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a single midline handport incision

Abstract

Objectives. To present one of the first known series of bilateral, transperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a hand-assisted technique by way of a single, midline HandPort incision. Synchronous, bilateral nephrectomy for autosomal dominant polycystic kidney disease is an infrequently performed procedure, with only a few reports using laparoscopy. Methods. We retrospectively reviewed the charts of 4 patients undergoing bilateral hand-assisted laparoscopic nephrectomy for symptomatic autosomal dominant polycystic kidney disease between June 2000 and January 2001. Follow-up consisted of chart review and telephone survey. Results. All 4 patients underwent successful bilateral hand-assisted laparoscopic nephrectomy, with a mean operative time of 286 minutes. This included 1 patient who underwent simultaneous laparoscopic marsupialization of symptomatic hepatic cysts. The average size of the polycystic kidneys removed was 1582 g. Complications included acute tubular necrosis of a renal allograft in 1 patient that resolved spontaneously and retained retroperitoneal cystic fluid that required percutaneous drainage in another patient. All patients did well postoperatively, with complete resolution of their presenting symptoms. Those with renal allografts had stable function at the last follow-up visit. Conclusions. Bilateral hand-assisted laparoscopic nephrectomy using a single HandPort incision is a feasible alternative for the removal of symptomatic polycystic kidneys. It offers the advantage of easier identification and control of hilar structures that are often obscured by the distorted renal anatomy. In addition, it allows the simultaneous performance of other intra-abdominal procedures.