title: Laparoscopic bilateral native nephrectomies with simultaneous kidney transplantation.
abstract: Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Extirpation of polycystic kidneys for various medical reasons has been performed using many different approaches in attempts to limit morbidity from such a large operation. In indicated patients, it has usually been offered in a staged approach with renal transplantation to avoid graft complications. We published the first case of simultaneous laparoscopic bilateral native nephrectomy with kidney transplant in 2008. The present study shows our continued experience with offering this minimally invasive, single surgery alternative. The results are comparable to a staged laparoscopic approach with significantly shorter total hospital stay and one recovery for the patient and his/her family.
  
  
  OBJECTIVE
  • To analyse the perioperative outcomes of native bilateral laparoscopic nephrectomy (BLN) with simultaneous kidney transplantation.
  
  
  METHODS
  • From November 2000 to April 2011, 37 patients were seen for renal failure secondary to autosomal-dominant polycystic kidney disease (ADPKD) and underwent renal transplant with native nephrectomies at a single tertiary academic centre. • In all, 15 patients underwent BLN for ADPKD followed by simultaneous kidney transplantation. • The other 22 patients underwent BLN for ADPKD with kidney transplant performed at a separate setting. • Demographic data, perioperative outcomes, complications regardless of need for intervention, and graft function were analysed in both groups.
  
  
  RESULTS
  • The combined surgery was completed without intraoperative complication in all cases. • The median total operative duration was 372 min, estimated blood loss was 300 mL with two patients requiring transfusion, and the median (range) hospital stay was 5 (3-7) days. • All patients had immediate graft function with additional relief of compressive symptoms. • In comparison to our staged cohort, the simultaneous group had a significantly shorter total hospital stay. • All other outcomes and complication rates were comparable.
  
  
  CONCLUSIONS
  • In ADPKD, a less invasive laparoscopic approach for native nephrectomies with simultaneous renal transplant offers comparable morbidity without graft compromise and the convenience of one operation and one recovery for the patient.
authors.affiliation: Department of Urology, Mayo Clinic, Phoenix, AZ, USA. aamartin@cnmc.org
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Martin
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Mekeel
authors.forename: Erik P
authors.initials: EP
authors.lastname: Castle
authors.forename: Sneha S
authors.initials: SS
authors.lastname: Vaish
authors.forename: George L
authors.initials: GL
authors.lastname: Martin
authors.forename: Adyr A
authors.initials: AA
authors.lastname: Moss
authors.forename: David C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Heilman
authors.forename: Kunam S
authors.initials: KS
authors.lastname: Reddy
authors.forename: Paul E
authors.initials: PE
authors.lastname: Andrews
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016891:Polycystic Kidney, Autosomal Dominant / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult