Laparoscopic nephrectomy with intact specimen extraction for polycystic kidney disease.

PURPOSE: We present our technique and evaluate the experience of laparoscopic nephrectomy with intact specimen extraction for patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIALS AND METHODS: We retrospectively reviewed 16 laparoscopic nephrectomies performed by one laparoscopic surgeon in a university hospital between April 2004 and March 2006. Preoperative, intraoperative, and postoperative follow-up data are presented. A 3- to 4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which was then removed intact through a Pfannenstiel or infraumbilical midline incision. RESULTS: A total of 16 patients were included in this study over a 2-year period. The average patient age was 49 years (range 29-67 years), and the average body mass index was 26.9 kg/m(2) (range 19.1-38.3 kg/m(2)). Eleven (69%) patients were receiving dialysis. The mean preoperative creatinine level was 520 mumol/L (range 108-976 mumol/L). Ten right (63%) and six left (37%) nephrectomies were performed. No patient had preoperative embolization. The mean operative time was 167 minutes (range 95-233 min). The mean blood loss was 76 mL (range 10-200 mL). No patient received a blood transfusion. The mean kidney pathologic size was 23 cm (range 16-35 cm), while the mean extraction size was 10.4 cm (range 8-12 cm). There were no deaths. There was one intraoperative complication (6.25%) and three postoperative ones (19%). No procedure was converted to an open approach. The mean length of hospital stay was 4 days (range 2-11 d). CONCLUSIONS: Laparoscopic nephrectomy for ADPKD is technically feasible and clinically safe. In addition to its low morbidity, other advantages of laparoscopic surgery are the ability to remove the dissected kidney through a small incision, short hospital stay, excellent cosmesis, and fast recovery.

Laparoscopic pyeloplasty: the updated McMaster University experience.

OBJECTIVE: The open Anderson-Hynes procedure has an overall success rate of 90% for ureteropelvic junction obstruction. Laparoscopic pyeloplasty (LP) was developed to reduce morbidity and hospital stay while preserving the excellent results. We report on the results of our experience with laparoscopic pyeloplasty. METHODS: Between January 2001 and May 2006, 77 consecutive patients underwent LP performed by one of 4 surgeons at our institution. Patients were reassessed with ultrasound (U/S) or intravenous pyelogram (IVP) at 6 weeks. Diuretic renal scan and U/S or IVP were performed at 6 months, and subsequent follow-up included a U/S or IVP as well as clinical assessment. Patients were assessed for pain and hydronephrosis on radiologic imaging, clearance on diuretic renal scan (T(1/2)) and differential renal function. RESULTS: We evaluated 73 patients. The mean patient age was 38 years (range 16-71 yr), the mean operating time was 218 minutes (range 110-409 min), and the mean blood loss was 57 mL (range 25-250 mL). Mean hospital stay was 3.0 days (range 2-7 d). The success rate was 90.4%, and failures were mainly due to poor function after surgery (3 patients). Pyelolithotomy was performed concomitantly on 6 patients, which on average extended operative time by 36 minutes. CONCLUSION: Our success rates are consistent with the LP experience of other centres and are comparable with rates for the open technique. Patients had short hospital stays, and complications were negligible. With experienced surgeons, LP should be the first-line treatment for ureteropelvic junction obstruction.