Bilateral laparoscopic radical nephrectomy for renal tumors in patients with acquired cystic kidney disease.
OBJECTIVE
We describe our experience with simultaneous bilateral laparoscopic radical nephrectomy performed in patients with acquired cystic kidney disease (ACKD) and renal tumors.


METHODS
Between June 2000 and September 2002, 10 patients with ACKD underwent simultaneous bilateral laparoscopic radical nephrectomy for renal lesions suspicious for carcinoma. The lesions were discovered during pretransplant evaluation in 9 patients and incidentally in 1 renal transplant recipient. A 3- or 4-port transperitoneal approach was used for each side to mobilize the kidney and secure the renal hilum. Both specimens were extracted through a midline supraumbilical incision. Operative time, blood loss, analgesic requirements, hospital stay, and convalescence and recurrence rates were determined.


RESULTS
The mean age of the patients was 41.6 years (range, 29-47 years). Mean operative time was 6.5 hours (range, 4.5-9.7 hours) and mean estimated blood loss was 164 cc (range, 50-300 cc). There was one intraoperative complication-a clotted arteriovenous (AV) graft; and 2 postoperative complications-1 fluid overload and 1 adrenal insufficiency. The average length of hospital stay was 3.1 days (range, 2-4 days) and mean convalescence was 2.8 weeks (range, 1-6 weeks). All cancers were confined to the kidneys and there has been no recurrence during follow-up ranging from 6 to 26 months.


CONCLUSIONS
Bilateral laparoscopic radical nephrectomy in end-stage renal disease patients is safe and feasible. The advantages of the laparoscopic approach include minimal intraoperative blood loss, shorter hospital stay, minimal postoperative pain, and a rapid return to normal activity. The laparoscopic technique offers an effective, minimally invasive therapeutic alternative to open surgery in high-risk end-stage renal disease patients.
Ghasemian
S Reza
SR
Department of Urology, Washington Hospital Center, Washington, DC 20010, USA. syed.ghasemian@medstar.net
Pedraza
Roberto
R
Sasaki
Truman A
TA
Light
Jimmy A
JA
Patel
Sunil V
SV
D000328:Adult; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000150:complications / Q000601:surgery*; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D012008:Recurrence; D016896:Treatment Outcome