title: Laparoscopic nephrectomy for autosomal dominant polycystic kidneys in patients with end-stage renal disease on maintenance hemodialysis: 10-year single surgeon experience from an Indian center.
abstract: BACKGROUND
  Pure laparoscopic nephrectomy in patients with ADPKD (autosomal dominant polycystic kidney disease) and ESRD (end-stage renal disease) on MHD (maintenance hemodialysis) is challenging with high incidence of complications. Limited experiences from India has been reported in these scenarios.
  
  
  OBJECTIVE
  To present a 10-year single surgeon experience from India in laparoscopic nephrectomy in autosomal dominant polycystic kidneys (ADPKD) and end-stage renal disease (ESRD) on maintenance hemodialysis (MHD).
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Retrospective analysis of records of similar subset of patients who were offered laparoscopic nephrectomy between 2003 and 2012. Preoperative, operative and postoperative parameters were recorded. Few technical modifications were adopted over the years. Patients were sub-classified into two groups (Group I: 2003-2006, Group II: 2007-2012) based on surgical technique.
  
  
  METHODS
  SAS software 9.1 version.
  
  
  RESULTS
  75 patients (84 renal units, Group I: 31, Group II: 53) were included in this analysis. Unilateral procedure was performed in 66 and bilateral staged or simultaneous procedure in 9. Despite larger kidneys in Group II (mean longitudinal renal length 25.7 ± 3.4 vs 17.5 ± 2.7 centimeters, P <0.001), improved operative and postoperative profile were noted in Group II in several parameters-mean total operative time (205 ± 11.5 vs 310 ± 15.3 min, P = 0.00), time for specimen retrieval (30.5 ± 3.5 vs 45 ± 4.1 min, P = 0.02), postprocedure drop in hemoglobin (1.1 ± 0.1 vs 2.27 ± 0.03 grams/deciliter, P = 0.00). Conversion rates, intraoperative and postoperative events were also considerably less in Group II.
  
  
  CONCLUSIONS
  Despite existence of comorbidities and technical difficulties, laparoscopic nephrectomy in patients with ADPKD with ESRD and on MHD is a feasible option. Technical modifications with increasing surgeon's experience allows successful conductance of this approach in more complex cases with better outcome.
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: George P
authors.initials: GP
authors.lastname: Abraham
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: Avinash T
authors.initials: AT
authors.lastname: Siddaiah
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: Krishanu
authors.initials: K
authors.lastname: Das
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: Krishnamohan
authors.initials: K
authors.lastname: Ramaswami
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: Datson P
authors.initials: DP
authors.lastname: George
authors.affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.
authors.forename: Oppukeril S
authors.initials: OS
authors.lastname: Thampan
keywords: Laparoscopic nephrectomy in ADPKD is technically demanding.; Laparoscopy; Technical modifications and surgeon's experience with these cases are harbingers to successful outcome; nephrectomy; polycystic kidney