title: Transperitoneal laparoscopic nephrectomy for giant polycystic kidneys: a case control study.
abstract: OBJECTIVE
  To describe the technique and compare the surgical outcomes of patients with autosomal dominant polycystic kidney disease (ADPKD) undergoing laparoscopic or open nephrectomy for giant kidneys.
  
  
  METHODS
  The surgical outcome of our first 10 consecutive patients with ADPKD who underwent laparoscopic nephrectomy was analyzed from a large prospective computer database. The results were compared with the 10 most recent open nephrectomy procedures performed for ADPKD at the same institution. To facilitate safe laparoscopic hilar dissection, the kidneys were made manageable by volume reduction, accomplished through diligent cyst puncture and aspiration using a novel prototype suction device with a beveled tip.
  
  
  RESULTS
  No statistically significant differences were found between the laparoscopic and open surgical groups relative to patient sex, age, or median preoperative kidney size (24.0 versus 21.5 cm, respectively). The laparoscopic patients were significantly heavier than their open counterparts (94 versus 78 kg, P = 0.0095) and had a longer operative time (247 versus 205 minutes, P = 0.04). One conversion to open surgery occurred in the laparoscopic group because cysts were adherent to the spleen and colonic mesentery. No intraoperative complications or deaths occurred in either group and the postoperative complications were similar. The mean length of the postoperative hospitalization was markedly reduced with the laparoscopic compared with the open approach (2.6 versus 6.6 days, P = 0.00002). At a median of 12 months after surgery, none of the laparoscopic patients had recurrent pain, bleeding, or infection.
  
  
  CONCLUSIONS
  Laparoscopic nephrectomy is technically safe and feasible in patients with ADPKD. Progressive cyst aspiration is a critical step, facilitating the identification of vital structures and the creation of enough abdominal cavity space to operate. The advantages of this minimally invasive technique include a short hospital stay, minimal pain, low morbidity, and superior cosmesis.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: P A
authors.initials: PA
authors.lastname: Seshadri
authors.forename: E C
authors.initials: EC
authors.lastname: Poulin
authors.forename: D
authors.initials: D
authors.lastname: Pace
authors.forename: C M
authors.initials: CM
authors.lastname: Schlachta
authors.forename: M O
authors.initials: MO
authors.lastname: Cadeddu
authors.forename: J
authors.initials: J
authors.lastname: Mamazza
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D007690:Polycystic Kidney Diseases / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome