Laparoscopic retroperitoneal nephrectomy for Aspergillus-infected polycystic kidney

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.