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At least 397 records · Page 22Linked to original sources

PubMed2006

Multidetector computerized tomography angiography to predict lumbar venous anatomy before donor nephrectomy.

PURPOSE: Multidetector computerized tomography angiography has been used to predict renal anatomy before donor nephrectomy. Unrecognized lumbar veins represent a significant risk during laparoscopic surgery but to our knowledge no previous group has attempted to predict lumbar veins with multidetector computerized tomography angiography before laparoscopic donor nephrectomy. We evaluated the ability of multidetector computerized tomography angiography to preoperatively predict the size and location of anomalous left lumbar veins. MATERIALS AND METHODS: A prospective study was performed in patients undergoing left hand assisted laparoscopic donor nephrectomy from January 2003 to September 2004. All patients were imaged using 4-phase computerized tomography, including computerized tomography angiography with 1.25 mm collimation of the arterial and venous phases. Each multidetector computerized tomography angiogram was prospectively reviewed by a radiologist and operating surgeon, and retrospectively reviewed by a second blinded radiologist. RESULTS: A total of 70 patients underwent left hand assisted laparoscopic donor nephrectomy between January 2003 and September 2004. Five patients underwent imaging elsewhere and were excluded from study. Of the remaining 65 patients 54 (83%) had at least 1 anomalous lumbar vein of any size recognized at surgery. Additionally, 33 of these 65 patients (51%) had an anomalous lumbar vein that was 3 mm or greater. These 3 mm or greater vessels carry a significant risk of bleeding and they were used in further calculations. As read by a radiologist and surgeon, the sensitivity and specificity of multidetector computerized tomography angiography compared to surgical identification were 97% and 91%, respectively. Positive and negative predictive values, and accuracy were 91.4%, 97% and 94%, respectively. CONCLUSIONS: Multidetector computerized tomography angiography accurately predicts lumbar venous anatomy before donor nephrectomy with high sensitivity, specificity and accuracy.

Adult↗

PubMed2004

Hand-assisted transperitoneal laparoscopic living donor nephrectomy.

OBJECTIVE: We introduced and evaluated the advantages and disadvantages of the hand-assisted transperitoneal laparoscopic technique for living donor nephrectomy. MATERIALS AND METHODS: In December 2001, we started using the technique of hand-assisted transperitoneal laparoscopic living donor nephrectomy (HLDN) in 10 cases. The procedure utilizes a hand-assisted device to increase safety and control of the laparoscopic technique. RESULTS: Only left nephrectomy was performed. The mean total operating and the warm ischemia times were 130 minutes and 3.0 minutes, respectively. Average lengths of renal artery and vein were 1.95 cm and 2.8 cm, respectively. There were no intraoperative or postoperative complications. CONCLUSIONS: HLDN is an easier procedure than the traditional laparoscopic living donor nephrectomy and can greatly mitigate the learning curve. HLDN has shortened warm ischemia time and operating time. It is also good for trocar placement, prevention of torsion of the kidney, control of potential bleeding at the final stage of vascular stapling, and kidney removal. Therefore, HLDN is a promising method for living donor nephrectomy.

Adult↗

PubMed2005

Intra- and postoperative complications of donor nephrectomies.

INTRODUCTION: Living-donor renal transplantation has become common worldwide. However, living-donor nephrectomy is not a complication-free procedure. This retrospective study reviews the intra-and postoperative risks and complications of donor nephrectomies at our institution between 1994 and 2002. METHOD: Two hundred fifty-seven consecutive donor nephrectomy patients were evaluated using medical records and anesthetic charts. RESULTS: The mean age of living donors was 42 +/- 12 years: 19 were older than 61 years, and 143 (55.6%) were women. Anesthesia for donor nephrectomy included general anesthesia, combined spinal-epidural anesthesia (CSE), general + CSE, and general + epidural anesthesia. We observed 51 intra- and postoperative complications in 26 patients. The minor complication rate was 10.1%. The duration of surgery was 3.56 +/- 0.26 hours (range, 2 to 5 hours). Serum creatinine levels were increased significantly (P < .05) on postoperative days 1, 3, and 5 compared with the preoperative levels (P < .05). There was no mortality. CONCLUSIONS: Like other surgical operations, living-donor nephrectomy is associated with intra- and postoperative complications. Although these complications are minor, maximal efforts must be applied in the anesthetic approach to minimize donor complications, and donors should be informed about potential risks.

Adult↗

PubMed2005

Concomitant nephrectomy of massively enlarged kidneys and renal transplantation in autosomal dominant polycystic kidney disease.

OBJECTIVES: We compared perioperative and intraoperative data of patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (ADPKD) who received a renal allograft without native nephrectomy with ADPKD patients who underwent concomitant native nephrectomy of massively enlarged kidneys and renal transplantation to determine whether the latter approach is reasonable and safe. PATIENTS AND METHODS: From January 1987 to December 2003, 13 patients with ESRD due to ADPKD were stratified as 6 patients who underwent bilateral and 7 patients who underwent unilateral native nephrectomy in conjunction with renal transplantation (group A), versus 20 patients with ESRD due to ADPKD underwent renal transplantation without native nephrectomy (group B). Operative time, need for intraoperative transfusion, time to oral intake, duration of hospital stay, serum creatinine level on the day of discharge, readmission rate, and postoperative complications were compared for both groups. RESULTS: Mean intraoperative duration was significantly longer for patients in group A, but there was no statistically significant difference in the findings between both groups. CONCLUSIONS: Concomitant native nephrectomy of massively enlarged kidneys at the time of renal transplantation is reasonable and safe for patients with ESRD due to ADPKD.

Adult↗

PubMedDate not supplied

Simultaneous transabdominal bilateral nephrectomy in potential kidney transplant recipients.

BACKGROUND: Bilateral nephrectomy of potential kidney graft recipients is indicated for patients with recurrent infections in the polycystic kidneys or chronic pyelonephritis resulting from vesicoureteric reflux. The aim of this study was to analyze the frequency of complications after simultaneous bilateral transperitoneal nephrectomy. PATIENTS AND METHODS: Twenty hemodialysis patients (age 28 to 55 years) were referred for simultaneous bilateral nephrectomy between 1996 and 2004. Among the 18 patients with autosomal-dominant polycystic kidney disease, 11 experienced recurrent cysts or urinary tract infections and two, episodes of disabling flank pain. Five patients with extremely enlarged kidneys were asymptomatic. Two patients presented vesicoureteric reflux with chronic pyelonephritis. In all cases the kidneys were removed transperitoneally via a transverse or midline incision. RESULTS: Although no fatal outcome was recorded, three patients required brief hospitalizations in the intensive care unit. The only intraoperative complication was spleen injury in five patients. Surgical postoperative complications developed in nine patients (45%) including: extended drainage and delayed wound healing (n = 4), postoperative hernia (n = 3), prolonged abdominal pain (n = 3), perihepatic hematoma (n = 2), stress duodenal ulceration (n = 1), and subileus (n = 1). Five patients displayed thrombosis of their dialysis access, probably as a consequence of low blood pressure. After surgery 15 patients were placed on the waiting list and 10, successfully transplanted. CONCLUSION: Simultaneous transabdominal bilateral nephrectomy was associated with a high risk of postoperative complications, but may save the suffering associated with a repeated operation in potential kidney graft recipients who have an indication for bilateral nephrectomy.

Abdomen↗

PubMed2004

Laparoscopic partial nephrectomy with temporary arterial occlusion: description of technique and renal functional outcomes.

OBJECTIVES: To report our laparoscopic partial nephrectomy experience and the impact of temporary arterial occlusion during laparoscopic partial nephrectomy on postoperative renal function. Laparoscopic partial nephrectomy is increasingly popular but remains technically challenging. METHODS: Laparoscopic partial nephrectomy was performed in 27 patients, with arterial occlusion in 15 cases. Postoperative renal function was evaluated with serum creatinine in all patients and postoperative technetium-99m mercaptoacetyl triglycine renal scans in a subset of patients after arterial occlusion. RESULTS: The group with arterial occlusion (n = 15) did not differ from those without arterial occlusion (n = 12) with respect to age, body mass index, American Society of Anesthesiologists score, lesion size, operative time, blood loss, or complications. In patients undergoing arterial occlusion, the mean warm ischemia time was 43 +/- 10 minutes (range 25 to 65). The preoperative and postoperative serum creatinine levels were unchanged in patients with (1.07 +/- 0.4 to 1.15 +/- 0.4 ng/dL; P = 0.24) and without (0.96 +/- 0.22 to 1.07 +/- 0.27 ng/dL; P = 0.14) arterial occlusion. The tumor size on imaging correlated with postoperative serum creatinine (r2 = 0.450, P = 0.04). Nuclear renography was performed in 9 patients (60%) after renal artery occlusion. The mean differential renal function of the operated kidney (49%) was similar to that of the contralateral kidney (51%) and was not associated with warm ischemic time or tumor size. CONCLUSIONS: Temporary arterial occlusion during laparoscopic partial nephrectomy does not appear to affect short-term renal function adversely. We believe that this technique can be safely performed when significant bleeding or entry into the collecting system is anticipated. Additional study is warranted to identify the maximal time of warm ischemia and ways to reduce potential renal injury.

Adenoma, Oxyphilic↗

PubMed2004

Utility of frozen section analysis of resection margins during partial nephrectomy.

OBJECTIVES: To evaluate the utility of routine intraoperative frozen-section histologic analysis during partial nephrectomy to ensure negative surgical margins. Partial nephrectomy has gained acceptance for surgical treatment of small renal cancers. Many surgeons send specimens for intraoperative frozen section histologic analysis to ensure negative margins. METHODS: We reviewed the records of 78 patients who underwent partial nephrectomy for presumed malignancy. Patient demographics, intraoperative findings, and pathologic and clinical outcomes were analyzed. RESULTS: Seventy-nine partial nephrectomies were performed in 78 patients. Frozen sections were obtained intraoperatively in 76 cases. In 1 case (1.3%), a single margin was interpreted as positive for carcinoma, prompting deeper resection. The final histopathologic finding was interpreted as angiomyolipoma rather than carcinoma. The final pathologic examination revealed renal cell carcinoma in 52 (66%) of 79 cases. The mean oncologic follow-up was 16.2 months. One local recurrence was noted (1.9%). It arose in the resection bed 19 months after removal of a 4.5-cm tumor (pathologic Stage T3a). Both intraoperative frozen section margins and final pathologic margins were negative in this case. One patient developed pulmonary metastases and represented the only metastatic recurrence, as well as the only cancer-related death in our cohort (1.9%). CONCLUSIONS: Our data suggest that when partial nephrectomy is performed with attention to excising a perimeter of grossly normal-appearing parenchyma, sending specimens for intraoperative frozen section analyses may provide an unnecessary expense without providing meaningful, reliable information. Additional studies, including larger cohorts and extended follow-up, are needed to support these results.

Adenoma, Oxyphilic↗

PubMed2005

Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor.

We sought to compare perioperative and short-term outcomes of laparoscopic partial nephrectomy versus laparoscopic cryoablation in patients with peripheral small renal tumors. Prospectively accrued data of patients with a small renal tumor (< or = 3 cm) undergoing laparoscopic partial nephrectomy (group 1, n = 153) or laparoscopic cryoablation (group 2, n = 78) were compared retrospectively. Patients undergoing laparoscopic partial nephrectomy were younger (mean age, 60.6 vs 65.6 years; P = 0.005), healthier (American Society of Anesthesiologists class 3/4 present in 46% vs 75%; P = 0.001), had a lower baseline serum creatinine (90.1 vs 106.0 micromol/L [1.02 vs 1.2 mg/dL]; P = 0.01), a larger tumor size (2.3 vs 2.1 cm; P = 0.02), and fewer cases of solitary kidneys (5% vs 23%; P = 0.000). Laparoscopic partial nephrectomy was associated with greater blood loss (211 vs 101 mL; P = 0.000) and a higher incidence of delayed complications after hospital discharge (16.3% vs 2.2%; P = 0.01) compared with cryoablation. Both groups were comparable with regard to operative time (P = 0.77), intraoperative complications (P = 0.1), postoperative complications (P = 0.55), hospital stay (P = 0.13), convalescence (P = 0.96), and postoperative serum creatinine (112.2 vs 123.7 micromol/L [1.27 vs 1.4 mg/dL]; P = 0.31). Local recurrence was detected over a mean follow-up time of 5.8 months in group 1 (0.6%) and 24.6 months in group 2 (3%). Although the technical simplicity, decreased blood loss, and somewhat lower complication rate are attractive features of renal cryotherapy, this must be balanced against the current lack of long-term follow-up data that are needed to confirm the oncologic adequacy of this developmental procedure. Laparoscopic partial nephrectomy, albeit a technically advanced procedure, duplicates established open principles and has therefore evolved to become our current minimally invasive nephron-sparing procedure of choice in the majority of patients with a small renal tumor.

Adolescent↗

PubMed2006

Evolution of surgical technique and patient outcomes for laparoscopic partial nephrectomy.

OBJECTIVES: To review the operative technique, complication rates, and short-term oncologic efficacy of the first 60 laparoscopic partial nephrectomies performed by a single surgeon and to report changes in our technique and the associated outcomes. METHODS: Between January 2002 and December 2004, data regarding patient characteristics, intraoperative technique, and outcome of 60 consecutive patients undergoing laparoscopic partial nephrectomy were prospectively collected. RESULTS: All 60 procedures were successfully completed laparoscopically without conversion to an open or hand-assisted approach. Histopathologic examination revealed renal cell carcinoma in 60% of patients with no positive margins or recurrences at a mean follow-up of 25.3 months. The overall complication rate was 30.0%, with 8 urologic (13.3%) and 10 nonurologic (16.7%) complications. CONCLUSIONS: With experience, laparoscopic partial nephrectomy is a viable alternative to open partial nephrectomy for small renal masses. At present, energy technologies and surgical pharmaceuticals are helpful adjuncts, but are not reliable for primary hemostasis and collecting system closure. Adaptation of traditional open techniques, including vascular control, excision of the tumor with cold scissors, and suture reconstruction of the collecting system and parenchyma, remain necessary to consistently perform laparoscopic partial nephrectomy successfully.

Adult↗

PubMed2006

Laparoscopic partial nephrectomy using the potassium titanyl phosphate laser in a porcine model.

INTRODUCTION: To evaluate the potential and feasibility of the potassium titanyl phosphate (KTP) Greenlight laser to perform partial nephrectomy in a porcine model. TECHNICAL CONSIDERATIONS: A total of 15 laparoscopic partial nephrectomies were performed in 4 Danish land-raised pigs under anesthesia. Transperitoneal access was obtained, and using a total of four ports, the 80-W KTP laser was used to perform bilateral upper and lower pole partial nephrectomy. The procedures were done successfully without renal cooling or clamping of the vessels. The estimated blood loss for each procedure was less than 30 mL. Only in one operation, in which a secondary renal vein was transected, was any additional hemostasis required (a single Endoclip). The mean operating time was 42 minutes (range 31 to 59) for each partial nephrectomy. As demonstrated on video, smoke formation was, at times, a problem during the procedure, because it reduced visibility, making only intermittent application of laser energy possible. Histopathologic analysis of the specimens showed a zone of loss of substance (less than 1 mm) at the resection line and narrow adjacent zones on both sides of the resection line with minimal changes. CONCLUSIONS: We have shown for the first time that normally perfused laparoscopic partial nephrectomy using the KTP laser is feasible and efficacious in the porcine model. This represents a novel application for the KTP laser, which produced excellent renal parenchymal hemostatic ablation. We are currently working on ways to improve the visibility by reducing smoke formation before undertaking a clinical trial in humans.

Animals↗

PubMed2002

[Role of partial nephrectomy in the treatment of kidney cancer].

Incidental finding of small renal carcinoma by radiologic exams (ultrasound, computed tomography, MRI) performed for non urological purposes raises therapeutic and management problems (therapeutic abstinence and surveillance, partial or radical nephrectomy). Radical nephrectomy is recognized as a curative treatment for renal cell carcinoma. However, partial nephrectomy was suggested for renal cell carcinoma of solitary functional kidney or bilateral tumors in order to avoid dialysis or renal transplantation. The debate remains open for the small renal carcinomas with a normal controlateral kidney. Is partial nephrectomy an adequate treatment or rather perform radical nephrectomy? The present study was performed to analyse the published literature on the subject.

Carcinoma, Renal Cell↗

PubMed1997

Laparoscopic bilateral nephrectomy: results in 11 renal transplant patients.

PURPOSE: We report our experience with bilateral laparoscopic nephrectomy after renal transplantation. MATERIALS AND METHODS: Between August 1994 and October 1995, 11 patients who had previously undergone renal transplantation underwent bilateral laparoscopic nephrectomy at our hospital due to poorly controlled hypertension. The records of 10 patients undergoing bilateral open nephrectomy were reviewed for comparison. RESULTS: Mean operative time in the laparoscopy group was 195 minutes (range 125 to 270). Mean blood loss was 345 ml. and 1 patient required conversion to an open operation. Oral intake and mobilization were begun 1 day postoperatively. Mean postoperative morphine equivalent consumption was 14 mg., mean hospital stay was 4.2 days (range 3 to 6) and mean return to normal activities was 14 days. At a mean followup of 10.4 months blood pressure had improved significantly in 8 patients (73%). Mean operative time in the open surgery group was 145 minutes (range 115 to 170) and mean postoperative morphine equivalent required was 44 mg. Compared to the laparoscopy group the interval to resumption of oral intake (3.5 days), duration of hospital stay (10.7 days) and return to normal activities (36 days) were prolonged in the open surgery group. CONCLUSIONS: According to our results, bilateral laparoscopic nephrectomy could be an effective alternative for the treatment of severe hypertension after renal transplantation. Compared to open nephrectomy most patients benefit from the laparoscopic approach.

Adult↗

PubMed2006

Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases.

PURPOSE: We present a series of 400 patients with tumor in a solitary kidney who underwent open surgical partial nephrectomy performed by a single surgeon (ACN) with a primary focus on postoperative long-term kidney function. MATERIALS AND METHODS: A total of 400 patients with sporadic nonfamilial kidney tumors in a solitary kidney underwent open partial nephrectomy between 1980 and 2002. In 323 patients (81%) the contralateral kidney had been surgically removed, while the remaining 77 (19%) had a congenital solitary kidney. Renal insufficiency was present preoperatively in 184 patients (46%). Adverse risk factors for partial nephrectomy were present in a large percent of patients. Intraoperative and postoperative parameters were evaluated at a mean followup of 44 months. RESULTS: In the overall series 5 and 10-year cancer specific survival was 89% and 82%, respectively. Surgical complications occurred in 52 patients (13%), most commonly urinary leakage. Early postoperative renal function was achieved in 398 patients (99.5%). Only 2 patients required permanent dialysis postoperatively. Satisfactory long-term renal function was achieved in 382 patients (95.5%). A total of 18 patients had progressed to renal failure a mean of 3.6 years after surgery. Patient age, the amount of renal parenchyma resected, a congenitally absent or atrophic contralateral kidney and the time of contralateral nephrectomy were noted to be significantly associated with postoperative renal function. CONCLUSIONS: Open surgical partial nephrectomy can be safely performed in patients with tumor in a solitary kidney. Long-term cancer-free survival with the preservation of renal function can be reliably expected in most of these cases.

Adolescent↗

PubMed2003

Partial nephrectomy safely preserves renal function in patients with a solitary kidney.

PURPOSE: We examined the success of partial nephrectomy in a group of patients in whom its role is paramount, namely those with a solitary kidney requiring surgery. MATERIALS AND METHODS: We reviewed the records of 84 consecutive patients who underwent partial nephrectomy from January 1995 to August 2000. Of these 84 patients 30 (36%) met our study criteria for an absolute indication for partial nephrectomy, which included namely a solitary kidney or bilateral renal masses for which radical nephrectomy was indicated for at least 1 renal unit. The variables examined included preoperative and postoperative renal function, pathological evaluation, surgical margins, major and minor complication rates, and the need for dialysis. RESULTS: At a median followup of 24 months (range 1 to 74) median creatinine had increased from 1.5 mg./dl. preoperatively to 1.8 postoperatively. None of the 30 patients required dialysis in the perioperative period. Of the tumors 22 (73%) were renal cell carcinoma and 4 (13%) were oncocytoma. All surgical margins were negative for malignancy and no patient has had local recurrence to date. Eventually but not immediately 2 patients with renal insufficiency preoperatively had progression to end stage renal disease, necessitating dialysis at long-term followup. CONCLUSIONS: In patients who require partial nephrectomy this procedure can safely preserve renal function and effectively treat malignancy.

Adult↗

PubMed1989

Surgery for duplex kidneys with ectopic ureters: ipsilateral ureteroureterostomy versus polar nephrectomy.

Conventional surgery for the ectopic ureter stresses polar nephrectomy, while preserving a functioning upper pole by ipsilateral ureteroureterostomy is performed less commonly. During the last 15 years we operated on 35 children for ectopic ureter. High ipsilateral ureteroureterostomy (15 patients) was performed when the upper pole cortex appeared to be smooth and pink, and the anastomosis was surgically feasible. Upper pole nephrectomy and upper ureterectomy (21 patients) were performed when the involved segment appeared grossly to be pale, cystic or otherwise abnormal. One low ipsilateral ureteroureterostomy was performed concomitant with contralateral ureteral reimplantation. Complications after ipsilateral ureteroureterostomy and partial nephrectomy were similar. Histological evidence of dysplasia of the polar nephrectomy specimens was focal in 7 patients (33 per cent), marked in 2 (10 per cent) and not detected in 12 (57 per cent). Ipsilateral ureteroureterostomy is an appropriate means to manage the ectopic ureter in selected cases because dysplasia in these upper pole renal units seldom is significant, and because ipsilateral ureteroureterostomy and polar nephrectomy have similar postoperative morbidity rates.

Child↗

PubMed2000

Laparoscopic nephrectomy in the markedly obese living renal donor.

OBJECTIVES: To determine whether laparoscopic living donor nephrectomy is safe and efficacious in markedly obese renal donors. METHODS: From 1996 to 1999, 431 laparoscopic living donor nephrectomies were performed. The markedly obese group consisted of 41 patients with a body mass index (BMI) greater than 35. Forty-one controls with a BMI less than 30 were matched to the obese donors by sex, age, race, and date of surgery. RESULTS: The markedly obese and control groups were closely matched in sex, race, age, serum creatinine level, creatinine clearance, HLA match to recipient, side of donated kidney, and experience level of the surgeons. The obese patients had a BMI range of 35.2 to 53.9 (mean 39.3), and the control patients had a BMI range of 18.4 to 29.0 (mean 24.3). Donor operations in the markedly obese were significantly longer by an average of 40 minutes. The greater intraoperative blood loss and longer extraction incision length seen in the markedly obese did not reach statistical significance. More and larger laparoscopic ports were used in the markedly obese. Obese donors were more likely to require conversion from laparoscopic nephrectomy to open nephrectomy than ideal-sized donors. The postoperative recovery of the gastrointestinal tract, hospitalization time, analgesic requirements, and total complications were equal in the two groups, although the obese donors' complications tended to be cardiopulmonary problems. The recipient graft function was equivalent between the two groups. CONCLUSIONS: Laparoscopic living donor nephrectomy is more difficult to perform in the markedly obese but is associated with an equivalent donor morbidity and recipient renal outcome.

Blood Loss, Surgical↗

PubMed2001

Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.

OBJECTIVES: To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations. METHODS: Two patients, aged 32 and 36 years, underwent laparoscopic nephrectomy and autotransplantation for treatment of severe proximal ureteral injuries. The injuries included a ureteropelvic junction avulsion and a proximal ureteral avulsion, respectively. Both patients had good functional renal parenchyma. A transperitoneal laparoscopic approach was used, and the kidney was removed by way of a Gibson incision. RESULTS: The procedures were successful, with immediate return of renal function in both patients. A pyeloureterostomy to the native distal ipsilateral ureter was required in one and a direct ureterovesical anastomosis was performed in the other. In the 2 patients, the warm ischemia time was 4.5 and 4 minutes, the transplant operative time 175 and 150 minutes, and the estimated blood loss 150 and 75 mL, respectively. No intraoperative complications occurred. At follow-up, the kidneys were functional, and the patients had returned to their normal activity. CONCLUSIONS: Laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomy or bowel interposition in patients with proximal ureteral loss, irrespective of the contralateral renal function. This procedure is associated with acceptable morbidity and preserves the renal function. This approach is desirable in those patients who have had complications from other surgical procedures and are otherwise facing the loss of a normally functioning kidney.

Adult↗

PubMed2002

Bilateral hand-assisted laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a single midline HandPort incision.

OBJECTIVES: To present one of the first known series of bilateral, transperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease using a hand-assisted technique by way of a single, midline HandPort incision. Synchronous, bilateral nephrectomy for autosomal dominant polycystic kidney disease is an infrequently performed procedure, with only a few reports using laparoscopy. METHODS: We retrospectively reviewed the charts of 4 patients undergoing bilateral hand-assisted laparoscopic nephrectomy for symptomatic autosomal dominant polycystic kidney disease between June 2000 and January 2001. Follow-up consisted of chart review and telephone survey. RESULTS: All 4 patients underwent successful bilateral hand-assisted laparoscopic nephrectomy, with a mean operative time of 286 minutes. This included 1 patient who underwent simultaneous laparoscopic marsupialization of symptomatic hepatic cysts. The average size of the polycystic kidneys removed was 1582 g. Complications included acute tubular necrosis of a renal allograft in 1 patient that resolved spontaneously and retained retroperitoneal cystic fluid that required percutaneous drainage in another patient. All patients did well postoperatively, with complete resolution of their presenting symptoms. Those with renal allografts had stable function at the last follow-up visit. CONCLUSIONS: Bilateral hand-assisted laparoscopic nephrectomy using a single HandPort incision is a feasible alternative for the removal of symptomatic polycystic kidneys. It offers the advantage of easier identification and control of hilar structures that are often obscured by the distorted renal anatomy. In addition, it allows the simultaneous performance of other intra-abdominal procedures.

Feasibility Studies↗