Investig Clin Urol.  2018 Jul;59(4):238-245. 10.4111/icu.2018.59.4.238.

Predictors and outcomes of laparoscopic nephrectomy in autosomal dominant polycystic kidney disease

• Chen K
• Tan YG
• Tan D
• Pek G
• Huang HH
• Sim SP

• KMID: 2414756
• DOI: http://doi.org/10.4111/icu.2018.59.4.238

Abstract

PURPOSE
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, and 20% of patients eventually require nephrectomies due to compressive symptoms or renal-related complications. Traditionally, nephrectomies were performed via the open approach in view of space constraints. We evaluate our institution's outcomes for laparoscopic nephrectomy (LN) for ADPKD.
MATERIALS AND METHODS
We retrospectively reviewed 33 patients with ADPKD who underwent nephrectomies from November 2005 to December 2016 at a tertiary institution. Preoperative kidney volume was calculated via the ellipsoid method by using computed tomography scan.
RESULTS
The median age was 51.0 years (interquartile range [IQR], 44.5-56.0 years). Sixteen patients (48.5%) underwent open nephrectomy (ON), 15 patients (45.5%) had LNs, and 2 patients (6.1%) had laparoscopic converted to ON due to dense adhesions. Thirteen patients had bilateral while 18 patients had unilateral nephrectomies. Median kidney volume in the open group was 1,042 cm3 (IQR, 753-2,365 cm3) versus 899 cm3 (IQR, 482-1,914 cm3) in the laparoscopy group and did not differ significantly. The operative time was comparable between both groups. Patients who underwent LN had lesser blood loss (350 mL vs. 650 mL; 95% confidence interval [CI], 1.822-3.533; p=0.016) and shorter length of hospital stay (4.0 days vs. 6.5 days; 95% CI, 1.445-5.755; p=0.001) compared to patients who underwent ON. Both groups had similar low morbidity rate and no mortality.
CONCLUSIONS
LN for ADPKD is a safe and effective alternative to ON independent of kidney size with comparable outcomes and benefits of minimally invasive surgery.

Keyword

Nephrectomy; Polycystic kidney diseases

MeSH Terms

Humans
Kidney
Kidney Diseases
Laparoscopy
Length of Stay
Methods
Minimally Invasive Surgical Procedures
Mortality
Nephrectomy*
Operative Time
Polycystic Kidney Diseases
Polycystic Kidney, Autosomal Dominant*
Retrospective Studies

Reference

1. Gabow PA. Autosomal dominant polycystic kidney disease. N Engl J Med. 1993; 329:332–342. PMID: 8321262.

2. Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet. 2007; 369:1287–1301. PMID: 17434405.

3. Grantham JJ. Clinical practice. Autosomal dominant polycystic kidney disease. N Engl J Med. 2008; 359:1477–1485. PMID: 18832246.

4. 2014 USRDS Annual Data Report. Chapter 1: Incidence, prevalence, patient characteristics, and treatment modalities. Am J Kidney Dis. 2015; 66(Suppl 1):93–110.

5. Woo KT. The Singapore Renal Registry: an overview. Singapore Med J. 1993; 34:157–163. PMID: 8266160.

6. Hajj P, Ferlicot S, Massoud W, Awad A, Hammoudi Y, Charpentier B, et al. Prevalence of renal cell carcinoma in patients with autosomal dominant polycystic kidney disease and chronic renal failure. Urology. 2009; 74:631–634. PMID: 19616833.

7. 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; 93:391–395. PMID: 21943464.

8. Guo P, Xu W, Li H, Ren T, Ni S, Ren M. Laparoscopic nephrectomy versus open nephrectomy for patients with autosomal dominant polycystic kidney disease: a systematic review and meta-analysis. PLoS One. 2015; 10:e0129317. PMID: 26053633.

9. Lim KS, Tay S, Gostelow M, Fook-Chong SMC, Ng LG. Does size really matter? A retrospective analysis of donor renal volume and its effects on renal function in donors after donation. J Biomed Graphics Comput. 2016; 6:14–21.

10. Breau RH, Clark E, Bruner B, Cervini P, Atwell T, Knoll G, et al. A simple method to estimate renal volume from computed tomography. Can Urol Assoc J. 2013; 7:189–192. PMID: 23826046.

11. Elashry OM, Nakada SY, Wolf JS Jr, McDougall EM, Clayman RV. Laparoscopy for adult polycystic kidney disease: a promising alternative. Am J Kidney Dis. 1996; 27:224–233. PMID: 8659498.

12. Gill IS, Kaouk JH, Hobart MG, Sung GT, Schweizer DK, Braun WE. Laparoscopic bilateral synchronous nephrectomy for autosomal dominant polycystic kidney disease: the initial experience. J Urol. 2001; 165:1093–1098. PMID: 11257645.

13. Wisenbaugh ES, Tyson MD 2nd, Castle EP, Humphreys MR, Andrews PE. Massive renal size is not a contraindication to a laparoscopic approach for bilateral native nephrectomies in autosomal dominant polycystic kidney disease (ADPKD). BJU Int. 2015; 115:796–801. PMID: 24903738.

14. Desai MR, Nandkishore SK, Ganpule A, Thimmegowda M. Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: a single centre experience. BJU Int. 2008; 101:94–97. PMID: 17922857.

15. Bendavid Y, Moloo H, Klein L, Burpee S, Schlachta CM, Poulin EC, et al. Laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. Surg Endosc. 2004; 18:751–754. PMID: 15026905.

16. Lipke MC, Bargman V, Milgrom M, Sundaram CP. Limitations of laparoscopy for bilateral nephrectomy for autosomal dominant polycystic kidney disease. J Urol. 2007; 177:627–631. PMID: 17222647.

17. Ivey BS, Lucas SM, Meyer CA, Emley TE, Bey A, Gardner TA, et al. Conversions in laparoscopic renal surgery: causes and outcomes. J Endourol. 2011; 25:1167–1173. PMID: 21671761.

18. Verhoest G, Delreux A, Mathieu R, Patard JJ, Vigneau C, Rioux-Leclercq N, et al. Transperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease. JSLS. 2012; 16:437–442. PMID: 23318070.

19. Eng M, Jones CM, Cannon RM, Marvin MR. Hand-assisted laparoscopic nephrectomy for polycystic kidney disease. JSLS. 2013; 17:279–284. PMID: 23925022.

20. Park SK, Olweny EO, Best SL, Tracy CR, Mir SA, Cadeddu JA. Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol. 2011; 60:1097–1104. PMID: 21856076.

21. Yu HY, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Hu JC. Use, costs and comparative effectiveness of robotic assisted, laparoscopic and open urological surgery. J Urol. 2012; 187:1392–1398. PMID: 22341274.

22. Binsaleh S, Luke PP, Nguan C, Kapoor A. Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique. Can J Urol. 2006; 13:3340–3345. PMID: 17187698.