title: A novel approach to bilateral hand-assisted laparoscopic nephrectomy for autosomal dominant polycystic kidney disease.
abstract: OBJECTIVE
  Laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is technically challenging. We describe our technique and present our experience with a transperitoneal hand-assisted laparoscopic (HAL) technique using a standard vacuum curettage system to reduce the size of the kidneys thereby facilitating nephrectomy.
  
  
  METHODS
  A retrospective review was completed of 10 consecutive patients undergoing bilateral HAL nephrectomy between March 2002 and October 2004 using the following technique. A hand port is positioned through a 6-7 cm periumbilical incision and port sites are placed at the midclavicular line (12 mm) and anterior axillary line (5 mm) on the side of the initial nephrectomy. After the renal vessels are divided and the kidney is completely mobilized a 12 mm curette is inserted through the medial port site. The Berkeley VC-10 Vacuum Curettage System (ACMI, Southborough, MA) is used to morcellate and aspirate the kidney providing a significant decrease in the overall size and allowing easy extraction through the midline incision. The procedure is repeated for the contralateral side.
  
  
  RESULTS
  All 10 patients underwent successful bilateral HAL nephrectomy with a mean operative time of 194 minutes. The average length of stay was 4.7 days. Patients with renal allografts had stable function at the time of discharge. The average size of the kidneys removed was 717 g and average length was 19 cm. All patients did well postoperatively with complete resolution of their presenting symptoms.
  
  
  CONCLUSIONS
  In patients with symptomatic ADPKD, bilateral HAL nephrectomy using the vacuum curettage system to minimize the size of the kidneys is fast, safe and effective.
authors.affiliation: Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA. matthew.whitten@hsc.utah.edu
authors.forename: M G
authors.initials: MG
authors.lastname: Whitten
authors.forename: W
authors.initials: W
authors.lastname: Van der Werf
authors.forename: L
authors.initials: L
authors.lastname: Belnap
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D016891:Polycystic Kidney, Autosomal Dominant / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014619:Vacuum Curettage