Gasless laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease

Abstract

Introduction. Autosomal dominant polycystic kidney disease (PKD) is one of the most common hereditary diseases leading to the development of end-stage renal failure. According to modern concepts, nephrectomy of polycystic-altered kidneys in such patients is performed in the event of complications, as well as in order to prepare for kidney transplantation. The creation of intense carboxyperitoneum leads to carbon dioxide resorption and the development of hypercapnia and respiratory acidosis in the patient. Taking into account the age of patients and the high incidence of cardiovascular and valvular pathology in patients with PKD, this fact becomes significant and can lead to the development of severe complications. The solution to this problem, in our opinion, is to perform laparoscopic nephrectomy under low-pressure carboxyperitoneum (LPC).
 Materials and methods. In the period from 2013 to 2018, 55 monolateral laparoscopic nephrectomies were performed in 36 patients with PKD. The study identified 2 groups of patients. The study group included 8 patients who were diagnosed at the preoperative stage with cardiovascular disease performed LPC (12 operations). The second group was represented by 28 patients who were operated laparoscopically with the creation of intense carboxyperitoneum (41 operations). Workspace when LPC was created with the help of laparolift – mechanical device for lifting the abdominal wall on the abdominal cavity.
 Results. The mean duration of surgery in the groups was 126 ± 18 and 114 ± 11 minutes, respectively (p < 0.05). Intraoperative blood loss was significantly different: in the comparison group – 225 ± 45 ml, in the study group – 440 ± 76 ml (p < 0.05). Mean blood pCO2 and pH levels in the study group were 38.2 ± 2.7 mm Hg and 7.371 ± 0.021, the comparison group – 44.4 ± 3.8 mm Hg and 7.231 ± 0.035 (p < 0,05). Among the patients who underwent LPC, there was one fatal outcome. The frequency of postoperative complications was 16.6% (2) in the study group and 12.2% (5) in the comparison group.
 Summary. Laparoscopic nephrectomy in conditions of low pressure carboxyperitoneum allows to completely avoid the development of hypercapnia and respiratory acidosis in the patient, to prevent severe cardiovascular complications despite the high risk of their development among patients with PKD.