Laparoscopic Pretransplant Nephrectomy with Morcellation in Autosomic-dominant Polycystic Kidney Disease Patients with End-stage Renal Disease

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2014 Aug 16

PMID 25125090

Citations 7

Authors

Anastasios D Asimakopoulos

Richard Gaston

Roberto Miano

Filippo Annino

Camille Mugnier

Lorenzo Dutto

Giuseppe Vespasiani

Enrico Spera

Jean-Luc Hoepffner

Thierry Piechaud

Affiliations

Soon will be listed here.

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.

Citing Articles

Systematic review and meta-analysis of the incidence of incisional hernia in urological surgery.

Calcerrada Alises E, Anton Rodriguez C, Medina Pedrique M, Berrevoet F, Cuccurullo D, Lopez Cano M Langenbecks Arch Surg. 2024; 409(1):166.

PMID: 38805110 DOI: 10.1007/s00423-024-03354-4.

Prevalence of Renal Neoplasia in Autosomal Dominant Polycystic Kidney Disease: Systematic Review and Meta-Analysis.

Drake A, Paynter J, Yim A, Tempo J, Manning T, Brennan J Nephron. 2024; 148(7):457-467.

PMID: 38301614 PMC: 11216357. DOI: 10.1159/000536245.

Laparoscopic Nephrectomy for Massive Kidneys in Polycystic Kidney Disease.

Collini A, Benigni R, Ruggieri G, Carmellini P JSLS. 2021; 25(1).

PMID: 33879988 PMC: 8035816. DOI: 10.4293/JSLS.2020.00107.

[Application of immunosuppressants in patients with autosomal dominant polycystic kidney disease after kidney transplantation].

Li Q, Li J, Yang F, Liu Y, Deng W, Liu R Nan Fang Yi Ke Da Xue Xue Bao. 2020; 40(4):538-543.

PMID: 32895143 PMC: 7225103. DOI: 10.12122/j.issn.1673-4254.2020.04.14.

A Novel Technique of Morcellation Using a Pneumovesicum After Holmium Laser Enucleation of the Prostate in Complicated Situations: Our Initial Experience and Tips.

Tae B, Jeon B, Choi H, Park J, Bae J Int Neurourol J. 2019; 23(1):46-55.

PMID: 30943694 PMC: 6449657. DOI: 10.5213/inj.1836180.090.

References

Gill I, Kaouk J, Hobart M, Sung G, Schweizer D, Braun W . Laparoscopic bilateral synchronous nephrectomy for autosomal dominant polycystic kidney disease: the initial experience. J Urol. 2001; 165(4):1093-8. View

Desai M, Nandkishore S, Ganpule A, Thimmegowda M . Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: a single centre experience. BJU Int. 2007; 101(1):94-7. DOI: 10.1111/j.1464-410X.2007.07229.x. View

Kirkman M, van Dellen D, Mehra S, Campbell B, Tavakoli A, Pararajasingam R . Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?. BJU Int. 2010; 108(4):590-4. DOI: 10.1111/j.1464-410X.2010.09938.x. View

Bendavid Y, Moloo H, Klein L, Burpee S, Schlachta C, Poulin E . Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. Surg Endosc. 2004; 18(5):751-4. DOI: 10.1007/s00464-003-9172-z. View

Hsi R, Ojogho O, Baldwin D . Analysis of techniques to secure the renal hilum during laparoscopic donor nephrectomy: review of the FDA database. Urology. 2009; 74(1):142-7. DOI: 10.1016/j.urology.2008.11.010. View

Lucas S, Mofunanya T, Goggins W, Sundaram C . Staged nephrectomy versus bilateral laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease. J Urol. 2010; 184(5):2054-9. DOI: 10.1016/j.juro.2010.06.150. View

Seshadri P, Poulin E, Pace D, Schlachta C, Cadeddu M, Mamazza J . Transperitoneal laparoscopic nephrectomy for giant polycystic kidneys: a case control study. Urology. 2001; 58(1):23-7. DOI: 10.1016/s0090-4295(01)01005-6. View

BENNETT A, Stewart W, Lazarus J . Bilateral nephrectomy in patients with polycystic renal disease. Surg Gynecol Obstet. 1973; 137(5):819-20. View

Dunn M, Portis A, Elbahnasy A, Shalhav A, ROTHSTEIN M, McDougall E . Laparoscopic nephrectomy in patients with end-stage renal disease and autosomal dominant polycystic kidney disease. Am J Kidney Dis. 2000; 35(4):720-5. DOI: 10.1016/s0272-6386(00)70021-7. View

10.

Schillinger F, Montagnac R, Jourdan A, Massia D, Brandt B, Toupance O . [Bilateral nephrectomy before renal transplantation in autosomal dominant polycystic renal disease]. Nephrologie. 1997; 18(5):181-6. View

11.

Patel P, Horsfield C, Compton F, Taylor J, Koffman G, Olsburgh J . Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease. Ann R Coll Surg Engl. 2011; 93(5):391-5. PMC: 3365458. DOI: 10.1308/003588411X582690. View

12.

Wyler S, Bachmann A, Ruszat R, Forster T, Hudolin T, Gasser T . Retroperitoneoscopic nephrectomy for autosomal dominant polycystic kidney disease: initial experience. Urol Int. 2007; 79(2):137-41. DOI: 10.1159/000106327. View

13.

Brazda E, Ofner D, Riedmann B, Spechtenhauser B, Margreiter R . The effect of nephrectomy on the outcome of renal transplantation in patients with polycystic kidney disease. Ann Transplant. 1996; 1(2):15-8. View

14.

Elashry O, Giusti G, Nadler R, McDougall E, Clayman R . Incisional hernia after laparoscopic nephrectomy with intact specimen removal: caveat emptor. J Urol. 1997; 158(2):363-9. View

15.

Nunes P, Mota A, Alves R, Figueiredo A, Parada B, Macario F . Simultaneous renal transplantation and native nephrectomy in patients with autosomal-dominant polycystic kidney disease. Transplant Proc. 2007; 39(8):2483-5. DOI: 10.1016/j.transproceed.2007.07.035. View

16.

Parfrey P, Bear J, Morgan J, Cramer B, McManamon P, GAULT M . The diagnosis and prognosis of autosomal dominant polycystic kidney disease. N Engl J Med. 1990; 323(16):1085-90. DOI: 10.1056/NEJM199010183231601. View

17.

Hsi R, Saint-Elie D, Zimmerman G, Baldwin D . Mechanisms of hemostatic failure during laparoscopic nephrectomy: review of Food and Drug Administration database. Urology. 2007; 70(5):888-92. DOI: 10.1016/j.urology.2007.06.1116. View

18.

Landman J, Lento P, Hassen W, Unger P, Waterhouse R . Feasibility of pathological evaluation of morcellated kidneys after radical nephrectomy. J Urol. 2000; 164(6):2086-9. View

19.

Knispel H, Klan R, Offermann G, Miller K . Transplantation in autosomal dominant polycystic kidney disease without nephrectomy. Urol Int. 1996; 56(2):75-8. DOI: 10.1159/000282815. View

20.

Sulikowski T, Tejchman K, Zietek Z, Rozanski J, Domanski L, Kaminski M . Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation. Transplant Proc. 2009; 41(1):177-80. DOI: 10.1016/j.transproceed.2008.10.034. View