Laparoscopic cyst decortication using the harmonic scalpel for symptomatic autosomal dominant polycystic kidney disease.
BACKGROUND
Management of acute and chronic pain in patients with autosomal dominant polycystic kidney disease (ADPKD) has, until recently, been limited to oral narcotic regimens, percutaneous drainage, open decortication, or nephrectomy.


METHODS
Five women and two men with a mean age of 44 (range 20-55) years underwent laparoscopic cyst decortication with the Harmonic Scalpel. All patients had end-stage renal disease secondary to ADPKD and pain attributed to their cyst disease. Two patients had simultaneous bilateral, one had staged bilateral, and remaining four patients had unilateral decortication. The mean follow-up was 14 months (range 2-29 months). Preoperative and postoperative pain was assessed using a standardized scale.


RESULTS
There were no intraoperative complication, and visible cysts were decorticated in a total of 10 renal units. There was a significant reduction in the pain scale, from a mean of 7.4/10 preoperatively to 2.3/10 on follow-up for the entire group (P < 0.0001). One patient reported recurrence of pain at 4 months, and bilateral nephrectomy was performed. Major complications included postoperative bleeding in two patients and readmission for ileus in one.


CONCLUSIONS
Laparoscopic decortication of painful renal cysts in ADPKD patients is a feasible procedure for symptomatic relief. The Harmonic Scalpel is a useful tool; however, it may not be adequate in preventing delayed bleeding.
McNally
M L
ML
Department of Urology, University of Rochester School of Medicine, New York 14642, USA. erdal_erturk@urmc.rochester.edu
Erturk
E
E
Oleyourryk
G
G
Schoeniger
L
L
D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010146:Pain / Q000503:physiopathology; D010166:Palliative Care; D016891:Polycystic Kidney, Autosomal Dominant / Q000503:physiopathology / Q000628:therapy*; D012008:Recurrence; D013525:Surgical Instruments; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation*