Retroperitoneoscopic nephrectomy for autosomal dominant polycystic kidney disease: initial experience

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Autosomal dominant polycystic kidney disease (ADPKD) often necessitates nephrectomy, a procedure associated with significant risks.
• Laparoscopic nephrectomy for ADPKD is challenging due to large kidney size, limiting previous reports.
• This study introduces and evaluates a retroperitoneoscopic technique for nephrectomy in ADPKD patients.

Observation:

• Retroperitoneoscopic nephrectomy was successfully performed in two patients using a four-port retroperitoneal access.
• The surgical technique involved securing hilar control, freeing the kidney, and subsequent extraction.
• Mean operative time was 155 minutes with an average blood loss of 125 ml.

Findings:

• No intraoperative complications were reported during the procedures.
• One patient experienced a postoperative retroperitoneal hematoma, managed conservatively with transfusion.
• The retroperitoneoscopic approach demonstrated feasibility for nephrectomy in ADPKD.

Implications:

• Retroperitoneoscopic nephrectomy provides efficient access to hilar vessels in large polycystic kidneys.
• The extraperitoneal route offers a distinct advantage over transperitoneal laparoscopy.
• This technique may represent a safer and more manageable surgical option for ADPKD patients requiring nephrectomy.