Laparoscopic retroperitoneal nephrectomy for Aspergillus-infected polycystic kidney
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Published on: March 15, 2024
Andrei Nadu1, András Hoznek, Laurent Salomon
1Service d'Urologie, CHU Henri Mondor, Créteil, France.
Background And Purpose:
The management of polycystic kidney disease is mostly restricted to conservative measures. However, nephrectomy may be indicated in particular cases, especially when there are infective complications. To decrease the morbidity of the procedure, the laparoscopic approach has become appealing. We present a laparoscopic retroperitoneal approach to complicated polycystic kidney disease in a high-risk patient. CASERESPORT: We performed right retroperitoneal laparoscopic nephrectomy in a 39-year-old man who had autosomal polycystic kidney disease and had undergone heart transplantation. The immunosuppressed patient presented with severe flank pain, generalized signs of infection, and acute renal insufficiency. With the patient in the right lateral decubitus position, the retroperitoneal space was entered by the open technique, and the posterior pararenal space was developed with finger dissection. Five trocars were used. After the renal vessels had been secured and divided, the cysts were successively punctured, gradually shrinking the operative specimen. The kidney was placed in an Endo-catch and removed after morcellation, with no need to enlarge the 2-cm lumbotomy. The operating time was 80 minutes, and the hospital stay was 4 days. Histologic examination revealed a polycystic kidney with Aspergillus infection.
Conclusion:
The laparoscopic approach is a less-invasive option for removing a polycystic kidney when nephrectomy is indicated. The retroperitoneal route has the advantage of minimizing infection risks because of the absence of peritoneal opening.
Insights
Laparoscopic retroperitoneal nephrectomy offers a minimally invasive option for managing complicated autosomal polycystic kidney disease. This approach reduces infection risks and hospital stay in high-risk patients.
Area of Science:
- Nephrology
- Minimally Invasive Surgery
- Transplantation
Background:
- Polycystic kidney disease (PKD) management is primarily conservative, but nephrectomy is sometimes necessary for complications like infection.
- Laparoscopic surgery offers a less invasive alternative to open nephrectomy, reducing patient morbidity.
- This case report details a laparoscopic retroperitoneal approach for a complicated PKD case in an immunosuppressed, high-risk patient.
Observation:
- A 39-year-old male with autosomal polycystic kidney disease and a history of heart transplantation presented with severe flank pain, infection, and acute renal insufficiency.
- A right retroperitoneal laparoscopic nephrectomy was performed using an open technique for retroperitoneal space entry and five trocars.
- The surgical technique involved puncturing cysts to shrink the specimen for removal via morcellation, avoiding the need for a larger incision.
Findings:
- The retroperitoneal laparoscopic nephrectomy was completed in 80 minutes with a 4-day hospital stay.
- Histological examination confirmed a polycystic kidney with Aspergillus infection.
- The procedure demonstrated feasibility and safety in a complex, high-risk patient.
Implications:
- The laparoscopic retroperitoneal approach is a viable, less-invasive option for indicated nephrectomies in polycystic kidney disease.
- This surgical route minimizes infection risks by avoiding peritoneal entry, crucial for immunosuppressed patients.
- Further research into laparoscopic techniques for PKD management can improve patient outcomes and reduce surgical complications.
