gms | German Medical Science

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder and accounts for 5-10% of all cases of kidney failure. Nephrectomy is performed in up to 20% of the patients due to compression symptoms, complications such as bleeding or infection or in preparation for kidney transplantation. The standard operating procedure for nephrectomy of large cystic kidneys is the open approach. We previously introduced the laparoscopic approach for those patients and now report the results of more than 50 consecutive cases.

Methods: All consecutive laparoscopic cystnephrectomies were performed at the surgical department of the Cologne University hospital between August 2021 and April 2024. For the surgical procedure patients were placed in a lateral position with the ipsilateral side up and a 30° backward inclination. An umbilical port was used as camera port and 3 further trocars were placed circumferentially. After installation of the capnoperitoneum the colon was mobilized and the ureter was localized and clipped. Hereafter, largest cysts were disrupted and cyst fluid was aspirated to minimize kidney volume followed by localization of the vascular pedicle which was subsequently dissected with a vascular stapler (Echelon Flex, Ethicon/Johnson & Johnson). After devascularization, the upper pole and the lateral retroperitoneal fixation of the kidney was mobilized and extracted through a suprapubic incision after fragmentation of the kidney in a large recovery bag.

Results: 52 consecutive patients underwent laparoscopic cystnephrectomy. Indications for surgery were preparation for transplantation in 32% (n=17), renal complications such as infection (27%; n=14) and bleeding (3%; n=2), compression symptoms (34%, n=18) and suspected malignancy (2%; n=1). Mean age of patients was 54 (± 9) years. Mean weight of cystic kidneys were 1715 g (±1241 g). None of the patients needed conversion to open surgery. 25% (n=13) had Clavien-Dindo II complications such as iv antibiotics or blood transfusion, one patient had Grade III complication and no patients had higher grades of complications. The mean hospital stay was 12 days (± 7 days).

Conclusion: In our patient cohort, laparoscopic cystnephrectomy has shown itself to be a safe procedure. Even for cystic kidneys with relatively high weight over 1500g its complication rate is low. Therefore the laparoscopic approach for cystnephrectomy is our new standard approach for those patients