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2015 ; 11
(3
): 187-92
Nephropedia Template TP
gab.com Text
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Laparoscopic nephrectomy for autosomal dominant polycystic kidneys in patients
with end-stage renal disease on maintenance hemodialysis: 10-year single surgeon
experience from an Indian center
#MMPMID26195877
Abraham GP
; Siddaiah AT
; Das K
; Ramaswami K
; George DP
; Thampan OS
J Minim Access Surg
2015[Jul]; 11
(3
): 187-92
PMID26195877
show ga
CONTEXT: Pure laparoscopic nephrectomy in patients with ADPKD (autosomal dominant
polycystic kidney disease) and ESRD (end-stage renal disease) on MHD (maintenance
hemodialysis) is challenging with high incidence of complications. Limited
experiences from India has been reported in these scenarios. AIMS: To present a
10-year single surgeon experience from India in laparoscopic nephrectomy in
autosomal dominant polycystic kidneys (ADPKD) and end-stage renal disease (ESRD)
on maintenance hemodialysis (MHD). SETTINGS AND DESIGN: Retrospective. MATERIALS
AND METHODS: Retrospective analysis of records of similar subset of patients who
were offered laparoscopic nephrectomy between 2003 and 2012. Preoperative,
operative and postoperative parameters were recorded. Few technical modifications
were adopted over the years. Patients were sub-classified into two groups (Group
I: 2003-2006, Group II: 2007-2012) based on surgical technique. STATISTICAL
ANALYSIS USED: SAS software 9.1 version. RESULTS: 75 patients (84 renal units,
Group I: 31, Group II: 53) were included in this analysis. Unilateral procedure
was performed in 66 and bilateral staged or simultaneous procedure in 9. Despite
larger kidneys in Group II (mean longitudinal renal length 25.7 ± 3.4 vs 17.5 ±
2.7 centimeters, P <0.001), improved operative and postoperative profile were
noted in Group II in several parameters-mean total operative time (205 ± 11.5 vs
310 ± 15.3 min, P = 0.00), time for specimen retrieval (30.5 ± 3.5 vs 45 ± 4.1
min, P = 0.02), postprocedure drop in hemoglobin (1.1 ± 0.1 vs 2.27 ± 0.03
grams/deciliter, P = 0.00). Conversion rates, intraoperative and postoperative
events were also considerably less in Group II. CONCLUSIONS: Despite existence of
comorbidities and technical difficulties, laparoscopic nephrectomy in patients
with ADPKD with ESRD and on MHD is a feasible option. Technical modifications
with increasing surgeon's experience allows successful conductance of this
approach in more complex cases with better outcome.