Abstract
Background
Laparoscopic nephrectomy (LN) in end-stage autosomic-dominant polycystic kidney disease (ADPKD) requires a large abdominal incision for the specimen extraction.
Objective
The objective of this study was to describe our technique of LN for end-stage ADPKD followed by morcellation (LNM) of the specimen and extraction through a minimal abdominal incision.
Methods
The medical records of 19 consecutive patients who underwent pretransplant LNM between 2008 and 2011 by a single experienced laparoscopic surgeon were analyzed. Morcellation was performed with the Gynecare Morcellex™ Tissue morcellator, Ethicon.
Results and limitations
All cases but one were completed laparoscopically. Mean specimen weight was 1,026.8 g. Mean duration of the procedure, estimated blood loss, and hospital stay were 131.3 min, 52.1 ml, and 7.9 days, respectively. Specimens were extracted through a 12-mm trocar in 10/18 patients and through a 3-cm incision in 9/18 cases. Postoperatively, three complications were observed (Clavien grades II, I, and II). The only case of incisional hernia was observed in the converted procedure. Major limitation of the study is its retrospective design.
Conclusions
In our preliminary series and in the hands of a very experienced laparoscopist, LNM for ADPKD appears as a modern, mini-invasive, and safe technique. Specimen’s extraction through a small abdominal incision reduces postoperative pain and incisional hernias and guarantees the final cosmetic result of laparoscopy. The reduced overall morbidity could reduce the period between nephrectomy and transplantation.
Similar content being viewed by others
References
Parfrey PS, Bear JC, Morgan J, Cramer BC, McManamon PJ, Gault MH, Churchill DN, Singh M, Hewitt R, Somlo S, Reeders ST (1990) The diagnosis and prognosis of autosomal dominant polycystic kidney disease. N Engl J Med 323(16):1085–1090
Binsaleh S, Al-Enezi A, Dong J, Kapoor A (2008) Laparoscopic nephrectomy with intact specimen extraction for polycystic kidney disease. J Endourol 22(4):675–680
Brazda E, Ofner D, Riedmann B, Spechtenhauser B, Margreiter R (1996) The effect of nephrectomy on the outcome of renal transplantation in patients with polycystic kidney disease. Ann Transpl 1(2):15–18
Florijin KW, Chang PC, Van den Woude FJ, van Bockel JH, van Saase JL (1994) Long-term cardiovascular morbidity and mortality in autosomal dominant polycystic kidney disease patients after renal transplantation. Transplantion 57:73–81
Bennett AH, Stewart W, Lazarus JM (1973) Bilateral nephrectomy in patients with polycystic renal disease. Surg Gynecol Obstet 137(5):819–820
Rayner BL, Cassidy MJ, Jacobsen JE, Pascoe MD, Pontin AR, van Zyl Smit R (1990) Is preliminary binephrectomy necessary in patients with autosomal dominant polycystic kidney disease undergoing renal transplantation? Clin Nephrol 34(3):122–124
Elashry OM, Nakada SY, Wolf JS Jr, McDougall EM, Clayman RV (1996) Laparoscopy for adult polycystic kidney disease: a promising alternative. Am J Kidney Dis 27(2):224–233
Gill IS, Kaouk JH, Hobart MG, Sung GT, Schweizer DK, Braun WE (2001) Laparoscopic bilateral synchronous nephrectomy for autosomal dominant polycystic kidney disease: the initial experience. J Urol 165(4):1093–1098
Desai MR, Nandkishore SK, Ganpule A, Thimmegowda M (2008) Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: s single centre experience. BJU Int 101(1):94–97
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Halvorson CR, Bremmer MS, Jacobs SC (2010) Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment. Int J Nephrol Renovasc Dis 3:69–83
Knispel HH, Klän R, Offermann G, Miller K (1996) Transplantation in autosomal dominant polycystic kidney disease without nephrectomy. Urol Int 56(2):75–78
Rozanski J, Kozlowska I, Myslak M, Domanski L, Sienko J, Ciechanowski K, Ostrowski M (2005) Pretransplant nephrectomy in patients with autosomal dominant polycystic kidney disease. Transpl Proc 37(2):666–668
Cohen D, Timsit MO, Chrétien Y, Thiounn N, Vassiliu V, Mamzer MF, Legendre C, Méjean A (2008) Place of nephrectomy in patients with autosomal dominant polycystic kidney disease waiting for renal transplantation. Prog Urol 18(10):642–649
Salehipour M, Jalaeian H, Salahi H, Bahador A, Davari HR, Nikeghbalian S, Sagheb MM, Raiss-Jalali GA, Roozbeh J, Behzadi S, Janghorban P, Sepas HN, Malek-Hosseini SA (2007) Are large nonfunctional kidneys risk factors for posttransplantation urinary tract infection in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease? Transpl Proc 39(4):887–888
Schillinger F, Montagnac R, Jourdan AL, Massia D, Brandt B, Toupance O, Chanard J (1997) Bilateral nephrectomy before renal transplantation in autosomal dominant polycystic renal disease]. Nephrologie 18(5):181–186
Sulikowski T, Tejchman K, Zietek Z, Rózański J, Domański L, Kamiński M, Sieńko J, Romanowski M, Nowacki M, Pabisiak K, Kaczmarczyk M, Ciechanowski K, Ciechanowicz A, Ostrowski M (2009) Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation. Transpl Proc 41(1):177–180
Lucas SM, Mofunanya TC, Goggins WC, Sundaram CP (2010) Staged nephrectomy versus bilateral laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease. J Urol 184(5):2054–2059
Nunes P, Mota A, Alves R, Figueiredo A, Parada B, Macário F, Rolo F (2007) Simultaneous renal transplantation and native nephrectomy in patients with autosomal-dominant polycystic kidney disease. Transpl Proc 39(8):2483–2485
Glassman DT, Nipkow L, Bartlett ST, Jacobs SC (2000) Bilateral nephrectomy with concomitant renal graft transplantation for autosomal dominant polycystic kidney disease. J Urol 164(3 Pt 1):661–664
Wagner MD, Prather JC, Barry JM (2007) Selective, concurrent bilateral nephrectomies at renal transplantation for autosomal dominant polycystic kidney disease. J Urol 177(6):2250–2254; discussion 2254
Kirkman MA, van Dellen D, Mehra S, Campbell BA, Tavakoli A, Pararajasingam R, Parrott NR, Riad HN, McWilliam L, Augustine T (2011) Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation? BJU Int 108(4):590–594
Dunn MD, Portis AJ, Elbahnasy AM, Shalhav AL, Rothstein M, McDougall EM, Clayman RV (2000) Laparoscopic nephrectomy in patients with end-stage renal disease and autosomal dominant polycystic kidney disease. Am J Kidney Dis 35(4):720–725
Seshadri PA, Poulin EC, Pace D, Schlachta CM, Cadeddu MO, Mamazza J (2001) Transperitoneal laparoscopic nephrectomy for giant polycystic kidneys: a case control study. Urology 58(1):23–27
Bendavid Y, Moloo H, Klein L, Burpee S, Schlachta CM, Poulin EC, Mamazza J (2004) Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. Surg Endosc 18(5):751–754
Wyler SF, Bachmann A, Ruszat R, Forster T, Hudolin T, Gasser TC, Sulser T (2007) Retroperitoneoscopic nephrectomy for autosomal dominant polycystic kidney disease: initial experience. Urol Int 79(2):137–141
Elashry OM, Giusti G, Nadler RB, McDougall EM, Clayman RV (1997) Incisional hernia after laparoscopic nephrectomy with intact specimen removal: caveat emptor. J Urol 158(2):363–369
Ivey BS, Lucas SM, Meyer CA, Emley TE, Bey A, Gardner TA, Sundaram CP (2011) Conversions in laparoscopic renal surgery: causes and outcomes. J Endourol 25(7):1167–1173
Patel P, Horsfield C, Compton F, Taylor J, Koffman G, Olsburgh J (2011) Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease. Ann R Coll Surg Engl 93(5):391–395
Landman J, Lento P, Hassen W, Unger P, Waterhouse R (2000) Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy. J Urol 164:2086–2089
Hsi RS, Saint-Elie DT, Zimmerman GJ, Baldwin DD (2007) Mechanisms of hemostatic failure during laparoscopic nephrectomy: review of Food and Drug Administration database. Urology 70(5):88
Hsi RS, Ojogho ON, Baldwin DD (2009) Analysis of techniques to secure the renal hilum during laparoscopic donor nephrectomy: review of the FDA database. Urology 74(1):142–147
Disclosures
Asimakopoulos, Gaston, Miano, Annino, Mugnier, Dutto, Vespasiani, Spera, Hoepffner, and Piechaud have no conflict of interests or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Asimakopoulos, A.D., Gaston, R., Miano, R. et al. Laparoscopic pretransplant nephrectomy with morcellation in autosomic-dominant polycystic kidney disease patients with end-stage renal disease. Surg Endosc 29, 236–244 (2015). https://doi.org/10.1007/s00464-014-3663-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3663-y