Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease

Abstract

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

Acute health events in adult patients with genetic disorders: The Marshfield Epidemiologic Study Area

“…22 Pneumothorax and cystic lungs have also been previously reported in adult polycystic kidney disease. [23][24][25] It is noteworthy that greater than half of the acute relevant musculoskeletal events were due to connective tissue protein abnormalities and neuromuscular abnormalities. These conditions can render an affected individual more susceptible to loss of balance, sprains, and falls.…”

Laparoscopic Nephrectomy for Adult Polycystic Kidney Disease: Safety, Feasibility, and Early Outcomes

“…Some surgeons may use the retroperitoneoscopic technique with preport placement ultrasonography-guided cyst 17.3 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) 1175 (900-1700) aspiration when dealing with very enlarged polycystic kidneys that fill almost half of the abdomen. The use of transabdominal ultrasonography-guided cyst aspiration before port placement makes space in the retroperitoneal area for port entry and balloon dissection.…”

“…The impact of this approach on the outcomes, however, is uncertain. Initial studies 10,13 investigating the safety, feasibility, and early results are small and inconclusive, but the evidence has not previously been appraised systematically.…”

Bilateral Nephrectomy of Huge Polycystic Kidneys Associated With a Rectus Abdominis Diastasis and Umbilical Hernia

“…In a series in which the handassisted technique was used, an infraumbilical medial incision of 7-14 cm length combined with 3 port incisions were reported. 9 In other studies, a medial incision of 7 cm incorporating the umbilicus, 8 calling for aspiration to empty the cyst, 8,10 with surgical time varying between 4.8 and 5.5 hours, were reported. With the laparoscopic technique, an incision of 8 to 10 cm was necessary, with surgical time of 4.4 hours.…”

“…Bilateral nephrectomy has been reported to be performed through the midline transabdominal approach, 5,6 lumbotomy, 7 hand-assisted, [8][9][10] or laparoscopy, 11 but none of these reports has described the repair of the rectus abdominis diastasis or umbilical hernia. Open nephrectomies are often followed by significant complications, in some cases leading to splenectomy, because of splenic lacerations that may occur during renal dissection; they may also lead to partial or complete adrenalectomy because of adrenal gland injury that occurs during blind blunt dissection of the upper pole of the kidney; other possible complications are subphrenic abscesses, 5 incisional hernias, 11 or to death of undescribed cause.…”