Laparoscopic removal of renal cysts in patients with ADPKD as an alternative method of treatment and patient preparation for kidney transplantation: preliminary results.
BACKGROUND
The most frequent genetic disease of the kidneys occurring in 1 of 1000 inhabitants is autosomal-dominant polycystic kidney disease (ADPKD). Growing renal cysts compress the kidney resulting in damage to parenchyma and functional disorders. Around 10% of these patients are dialyzed due to terminal renal insufficiency. With the advent of laparoscopic techniques, the idea of laparoscopic excision of cysts seemed a tempting alternative to nephrectomy. We assessed the preliminary results of laparoscopic treatment of polycystic kidneys compared with open nephrectomy for patients with ADPKD.


METHODS
Thirty ADPKD patients were treated between 2000 and 2004. Eleven procedures in five men and six women of mean age 51 years included laparoscopic cyst excisions. In the remaining 19 patients (six men and 13 women) of mean age 54 years, nephrectomy was done. Indications for surgery included pain due to compression by large cysts and cyst contamination. Patients after nephrectomy were prepared for renal transplantation when necessary.


RESULTS
Laparoscopic polycyst removal produced better effects than nephrectomy. Mean operative time was significantly shorter (86 minutes for cyst removal vs 108 minutes for nephrectomy; P < .05). Postoperative pain measured with the VAS scale was reduced in patients after laparoscopy. Hospital stay was shorter (5 vs 9 days), as well as time to recovery. Other benefits of laparoscopic cyst removal included maintained urination in the patient and no need for erythropoietin substitution, as well as reduced risk of cyst contamination. When eligible for renal transplantation, patients after laparoscopic polycyst removal have smaller kidneys that do not interfere with the graft and the risk of infection during immunosuppression seems lower.


CONCLUSIONS
Although larger series of patients are required in patients with ADPKD, laparoscopic polycyst removal seemed superior to early nephrectomy.
Sulikowski
T
T
Department of General Surgery and Transplantation, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland. sulikowskit@wp.pl
Kamiński
M
M
Rózański
J
J
Zietek
Z
Z
Domański
L
L
Majewski
W
W
Sieńko
J
J
Romanowski
M
M
Mizerski
A
A
Myślak
M
M
Tejchman
K
K
Pabisiak
K
K
Nowacki
M
M
Ostrowski
M
M
Ciechanowski
K
K
D005260:Female; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000601:surgery*; D016030:Kidney Transplantation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000601:surgery*; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D011300:Preoperative Care; D012189:Retrospective Studies