Pretransplant Bilateral Hand-Assisted Laparoscopic Nephrectomy in Adult Patients With Polycystic Kidney Disease

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Abstract

Laparoscopic procedures continue to gain popularity over traditional open procedures for a number of abdominal and pelvic surgeries. With increasing experience, the application of this technique is rising because it provides an alternative, less invasive, approach to various surgical procedures. Herein, we report our experience with adult patients with polycystic kidney disease, requiring bilateral laparoscopic nephrectomy before renal transplantation.

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Most cited references 12

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Autosomal dominant polycystic kidney disease.

Aaron Gabow (1993)

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Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy.

Andrew Campbell, Matthew Wolf, J Punch … (2001)

Laparoscopic live donor nephrectomy for renal transplantation is being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors. Relative advantages in terms of recovery provided by laparoscopy over standard open surgery have not been rigorously assessed. We hypothesized that laparoscopic as compared with open surgical live donor nephrectomy provides briefer, less intense, and more complete convalescence. Of 105 volunteer, adult, potential living-renal donors interested in the laparoscopic approach, 70 were randomly assigned to undergo either hand-assisted laparoscopic or open surgical live donor nephrectomy at a single referral center. Objective data and subjective recovery information obtained with telephone interviews and validated questionnaires administered 2 weeks, 6 weeks, and 6-12 months postoperatively were compared between the 23 laparoscopic and 27 open surgical patients. There was 47% less analgesic use (P=0.004), 35% shorter hospital stay (P=0.0001), 33% more rapid return to nonstrenuous activity (P=0.006), 23% sooner return to work (P=0.037), and 73% less pain 6 weeks postoperatively (P=0.004) in the laparoscopy group. Laparoscopic patients experienced complete recovery sooner (P=0.032) and had fewer long-term residual effects (P=0.0015). Laparoscopic donor nephrectomy is associated with a briefer, less intense, and more complete convalescence compared with the open surgical approach.

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Laparoscopic nephrectomy in patients with end-stage renal disease and autosomal dominant polycystic kidney disease.

Suzanna Dunn, Kathleen McDougall, R Clayman … (2000)

Autosomal dominant polycystic kidney disease (ADPKD) is often characterized by end-stage renal disease (ESRD) and problems including pain, hematuria, and infection. Open nephrectomy is curative; however, the morbidity of the procedure is considerable. Between 1995 and 1998, 11 laparoscopic nephrectomies were performed on nine symptomatic patients (five men and four women) with ESRD and ADPKD. Two patients underwent a staged bilateral laparoscopic nephrectomy. All patients presented with abdominal or flank pain and an abdominal mass. Other clinical problems included hypertension in eight patients, urinary tract infections in two patients, and gross hematuria in one patient. Seven patients were receiving long-term dialysis treatment, and two patients had undergone prior renal transplantation. Patients were evaluated for preoperative and postoperative pain, analgesic use, hospital course, and convalescence. The overall average operative time was 6.3 hours, with an average estimated blood loss of 153 mL. Eight nephrectomy specimens were removed by morcellation, and three specimens were removed intact through a 7- to 12-cm incision. The average hospital stay was 3 days, and the average time to normal activity was 5 weeks. With a mean follow-up of 31 months, all nine patients reported elimination of their preoperative pain based on a pain analogue score. Six major and two minor complications occurred, including blood transfusion, a vena cavotomy, splenic cyanosis, pulmonary embolism, clotted arteriovenous fistula, and brachial plexus injury. Incisional hernias occurred in two of the three patients who underwent open removal. One patient noted improvement, and two patients noted resolution of their hypertension postoperatively. Laparoscopic nephrectomy in patients with ADPKD and ESRD offers an effective alternative to open nephrectomy to manage renal-related pain. This procedure provides the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay, and rapid convalescence.

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Author and article information

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Department of Medicine, Louisiana State University Health Sciences Center, Shreveport Louisiana, USA

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Jul-Sep 2005

Volume: 9

Issue: 3

Pages: 262-265

Affiliations

Department of Medicine, Louisiana State University Health Sciences Center, Shreveport Louisiana, USA

Author notes

Address reprint requests to: Fahim Zaman, MD, Department of Medicine, Division of Nephrology and Hypertension, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA. Telephone: 318 675 7402, Fax: 318 675 5913, E-mail: fzaman@ 123456lsuhsc.edu

Article

PMC ID: 3015599

PubMed ID: 16121868

SO-VID: ff3ce6cb-1c74-4ef4-8561-e1de092d7de6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Pretransplant Bilateral Hand-Assisted Laparoscopic Nephrectomy in Adult Patients With Polycystic Kidney Disease

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Abstract

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Most cited references 12

Autosomal dominant polycystic kidney disease.

Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy.

Laparoscopic nephrectomy in patients with end-stage renal disease and autosomal dominant polycystic kidney disease.

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