Presented by: Shuichi Tatarano MD, PhD
Kagoshima University Hospital

Introduction

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder caused by mutations in the PKD1 and PKD2 genes that result in the kidneys becoming enlarged due to the formation of multiple cysts. Nephrectomy is commonly performed in patients with ADPKD because of abdominal distention due to increased renal volume, pressure symptoms on surrounding organs, and cyst infection. Open or laparoscopic surgery is the technique of choice, but laparoscopic surgery is more difficult than conventional laparoscopic nephrectomy due to renal size. We report on the results of our treatment of retroperitoneal laparoscopic nephrectomy.

Materials

Between 2019 and 2023, fifteen patients underwent retroperitoneal laparoscopic nephrectomy for ADPKD at Kagoshima University. All the surgery was done by the retroperitoneal approach using four ports. The specimen was removed from the additional incision, which connected port sites. In cases of concurrent kidney transplantation, the lower abdominal wound was extended for specimen extraction, and the operative time was defined as the time until nephrectomy. In addition, we retrospectively analyzed perioperative outcomes, including operative time, blood loss, and complications.

Results

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The median age was 55 years (49 - 62), and the sex was male in 9 cases and female in 6 patients. The median weight of the kidney was 1960 g (1160 - 2805), the maximum diameter was 23cm (20 - 25), the median operative time was 169 minutes (146 - 219), and the blood loss was 150 mL (30 - 210) including cyst fluid. Blood transfusions were performed in 6 patients, all of whom had undergone simultaneous renal transplantation and were transfused at the time of transplantation surgery. In pathology results, there were no cases of malignant disease. In addition, there were no significant complications in these cases.

Conclusion

Retroperitoneal laparoscopic nephrectomy for ADPKD was feasible and clinically safe. However, this study is limited by its single-center, retrospective analysis, and a small number of cases.

Funding

None

Lead Authors

Akihiko Mitsuke, MD
Kagoshima University Hospital

Takashi Sakaguchi, MD, PhD
Kagoshima University Hospital

Yasutoshi Yamada, MD, PhD
Kagoshima University Hospital

Hideki Enokida, MD, PhD
Kagoshima University Hospital