Presentation Authors: Kiyohiko Hotta*, Daiki Iwami, Jun Furumido, Sapporo, Japan, Ken Morita, Kushiro, Japan, Tatsu Tanabe, Asahikawa, Japan, Haruka Higuchi, Naoya Iwahara, Sapporo, Japan, Tango Mochizuki, Asahikawa, Japan, Takashige Abe, Sapporo, Japan, Kouichi Kanagawa, Asahikawa, Japan, Nobuo Shinohara, Sapporo, Japan
Introduction: Autosomal dominant polycystic kidney disease (ADPKD) leads to end stage kidney disease (ESKD) and the need for kidney transplantation (KTX). Native nephrectomy is required when the polycystic kidneys are too large to safely implant a renal transplant in the iliac fossa. Open nephrectomy (ON) using a flank incision for KTX is extremely invasive. Although transperitoneal laparoscopic nephrectomy for kidneys affected by ADPKD has been reported by some centers, the retroperitoneal approach is preferred, because the kidney is implanted in retroperitoneal space. Therefore, we used retroperitoneoscopic native nephrectomy (RN) for ADPKD.
Methods: Twenty consecutive kidney recipients (10 men, 10 women) were enrolled in this study. The mean age of the recipients was 54.5 Â± 9.6 years. Unilateral native nephrectomy was performed to allow for the creation of sufficient space just before KTX. RN was performed for 10 recipients, and ON for 10 recipients. In the RN procedure, the kidney is completely delivered with 4 ports (12mmÃ—2 ports and 5mmÃ—2 ports) and the kidney is then extracted through Gibson incision (15cm) made for KTX. In ON, the flank incision (20cm) for nephrectomy was made, followed by the Gibson incision (15cm) for KTX. We compared the perioperative outcomes and early complications for the two procedures.
Results: There was no difference in the age, gender and body mass index of the patients between the two groups. The operative time for nephrectomy, intraoperative blood loss and nephrectomized kidney weight were similar between the two groups. Conversion to open surgery was not observed in RN group. Although there was no intraoperative complication observed in RN, a pleura injury led to the insertion of thoracostomy catheter in the ON group. The frequency of post-operative analgesics was significantly lower in the RN group compared to that in the ON group (4.7 VS. 8.5 times, P < 0.05). Furthermore, the time to transit recovery was significantly shorter in the RN group than in the ON group (1.2 vs. 1.9 days, P < 0.05). There were no severe post-operative complications in both groups.
Conclusions: RN for ADPKD in KTX is well-tolerated and is less invasive compared to open surgery. These results suggest that RN could be a feasible option for nephrectomy with ADPKD undergoing KTX.