Category: Laparoscopic/ Robotic: Other
Introduction & Objective :
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 for ADPKD.
We retrospectively reviewed 33 patients with ADPKD who underwent nephrectomies from November 2005 to December 2016 at a tertiary institution. Pre-operative kidney volume was calculated via the ellipsoid method by using computerized tomography scan.
The median age was 51.0 years (IQR 44.5 – 56.0). 16 (48.5%) patients underwent open nephrectomy (ON), 15 (45.5%) had laparoscopic surgery (LN) and 2 (6.1%) had laparoscopic converted to open nephrectomy due to dense adhesions. 13 patients had bilateral while 18 patients had unilateral nephrectomies. Median kidney volume in the open group was 1042cm3 (IQR: 753 to 2365) versus 899 cm3 (IQR: 482 to 1914) 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 mls vs 650 mls, 95% CI 1.822 – 3.533, p = 0.016) and shorter length of hospital stay (4.0 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.
LN for ADPKD is a safe and effective alternative to open nephrectomy independent of kidney size with comparable outcomes and benefits of minimally invasive surgery.
Yu Guang Tan– Resident, Singapore General Hospital, Singapore, Singapore
Hong Hong Huang– Singapore, Singapore
Kenneth Chen– Associate Consultant, Singapore General Hospital, Singapore, Singapore
Allen Sim– Consultant, Singapore General Hospital, Singapore, Singapore
Ming Shan Darren Tan– House Officer , Ministry of Health Holdings, Singapore , Singapore, Singapore
Singapore General Hospital
Singapore, Not Applicable, Singapore