Laparoscopic Cyst Decortication in Autosomal Dominant Polycystic Kidney Disease: Impact on Pain, Hypertension, and Renal Function

Abstract

Background: We present our initial experience with laparoscopic renal denervation and cyst decortication for ADPKD related hypertension and pain. Methods: Twelve patients 36 to 67 years old previously diagnosed with ADPKD presented with hypertension and Pain. These 12 patients underwent laparoscopic renal denervation and cyst decortication of 12 kidneys. Results: Mean operative time was 78 minutes and mean hospital stay was 5.6 days. Mean systolic pressure decline was 21 mmHg, and mean diastolic pressure decline was 13 mmHg at a mean follow up of 15 months. All patients were pain-free at discharge home and remained pain-free at a mean follow up of 15 months. Conclusions: We believe that laparoscopic renal denervation plus cyst decortication is a promising option for uncontrolled ADPKD related hypertension and pain in adult population.

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors

“…The mean operating times of laparoscopic renal cyst surgery in previously published series, in which other surgical coagulation/cutting devices and conventional monopolar devices were used, range between 30 and 390 min, generally including the time for frozen section analyses, as well as cases with multiple cysts. 5,6,[13][14][15][16][17][18][19][20] The mean operating time in our series was 82.5 min. However, our series almost only included simple renal cysts, and therefore intraoperative frozen section was performed in two cases.…”

“…[13][14][15][16][17][18] This procedure not only effectively reduces pain but also improves hypertension and stabilizes renal function, delaying renal replacement therapy. 13,16 Intraoperative use of laparoscopic ultrasound allows identification of deeper cysts, and more than 600 cysts may be decorticated in one session in cases with ADPKD. 15 Despite limited experience in one case in our series, the use of bipolar PK scissors offers an additional advantage by eliminating time for extra coagulation and speeding up the procedure in laparoscopic decortication of polycystic kidneys.…”

Hypertension and Hydronephrosis: Rapid Resolution of High Blood Pressure Following Relief of Bilateral Ureteric Obstruction

“…26 Hypertensive APKD patients have a greater total renal volume, due to expansion of cysts, than their normotensive counterparts, 27 and cyst decompression can result in improvement in blood pressure. 28 Activity of the RAA axis is increased in hypertensive APKD patients compared to those with essential hypertension. 29 Taken together, these observations suggest that parenchymal compression by cysts, with consequent intra-renal ischemia, plays a role in the genesis of hypertension in APKD.…”

Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment

“…These include cyst decortication, which is now performed laparoscopically and has been found in a study of 29 ADPKD patients to result in a greater than 50% improvement in pain in 73%, 52%, and 81% of patients, at 12, 24, and 36 months, respectively. 131 Similarly, a different study of 15 ADPKD patients treated with laparoscopic decortication revealed that pain decreased an average of 62% in 73% of cases at a mean follow-up of 2.2 years (range 0.5-5). 132 Further studies are needed to determine the benefits of decortication for longer-term pain relief.…”