Limitations of Laparoscopy for Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

Lipke, Michael C.; Bargman, Vladislav; Milgrom, Martin L.; Sundaram, Chandru P.

doi:10.1016/j.juro.2006.09.026

Cited by 68 publications

(74 citation statements)

References 10 publications

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“…This procedure can be performed unilaterally or bilaterally which necessitates the use of dialysis or renal transplantation. Bilateral laparoscopic nephrectomy has been shown to decrease visual analog pain scores from an average of 6.9 out of 10 preoperatively to 0.5 at three month follow up in 18 patients studied, 43 with evidence of long-term pain relief at 31 months in a separate study. 44 The laparoscopic approach is generally preferred over an open procedure due to decreased blood loss, shorter recovery, and decreased pain.…”

Section: Nephrectomymentioning

confidence: 77%

“…44 Patients with extremely large kidneys with a volume greater than 3500cc are at an increased risk of conversion to an open procedure, thus open nephrectomy may initially be considered in these patients. 43 Unilateral nephrectomy with renal transplantation does not increase morbidity compared to renal transplantation alone in patients with ADPKD. Renal transplantation with unilateral nephrectomy followed by laparoscopic unilateral nephrectomy has a better perioperative outcome compared to renal transplantation followed by bilateral laparoscopic nephrectomy.…”

Section: Nephrectomymentioning

confidence: 99%

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Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

et al. 2015

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Purpose: Chronic pain is a prominent feature of autosomal dominant polycystic kidney disease (ADPKD) that is difficult to treat and manage, often resulting in a decrease in quality of life. Understanding the underlying anatomy of renal innervation and different etiologies of pain that occur in ADPKD can help to guide proper treatments to manage pain. Reviewing the previously studied treatments for pain in ADPKD can help to characterize treatment in a stepwise fashion. Materials and Methods: We performed a literature search of the etiology and management of pain in ADPKD and the anatomy of renal innervation using Pubmed® and Embase® from January 1985 to April 2014 with limitations to human studies and English language. Results: Pain occurs in the majority of patients with ADPKD due to renal, hepatic, and mechanical origins. Patients may experience different types of pain, which can make it difficult to clinically confirm its etiology. An anatomical and histological evaluation of the complex renal innervation helps with an understanding of the mechanisms that can lead to renal pain. Understanding the complex nature of renal innervation is essential for surgeons to perform a renal denervation procedure. The management of pain in ADPKD should be approached in a stepwise fashion. Acute causes of renal pain must first be ruled out due to the high incidence in ADPKD. For chronic pain, non-opioid analgesics and conservative interventions can be first used before opioid analgesics are considered. If pain continues, there are surgical interventions that can target pain produced by renal or hepatic cysts. Surgical options include renal cyst decortication, renal denervation, and nephrectomy. Conclusion: Chronic pain in patients with ADPKD is often refractory to conservative, medical, and other non-invasive treatments. There are effective surgical procedures that can be implemented when more conservative treatments fail. Laparoscopic cyst decortication has been well studied and results in relief of chronic renal pain in the majority of patients. In addition, renal denervation has successfully been utilized and could be performed concurrently with cyst decortication. Nephrectomy should be reserved for patients with intractable pain and renal failure when other modalities have failed.

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Section: Nephrectomymentioning

confidence: 77%

Section: Nephrectomymentioning

confidence: 99%

Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

et al. 2015

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“…The selection of appropriate surgical technique is also a matter of controversy, with the laparoscopic and handassisted approach gradually gaining more ground. Although technically challenging, a great number of studies, including a recent meta-analysis, indicated that laparoscopic nephrectomy, especially hand-assisted bilateral nephrectomy, is both safe and efficacious even for massively enlarged kidneys (19,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

Tailoring the ‘Perfect Fit’ for Renal Transplant Recipients with End-stage Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy

Argyrou

Moris

Vernadakis

2017

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“…Lipke and associates reported an increased incidence of conversion from laparoscopic to open surgery in patients with kidneys of a volume larger than 3500 mL in their series of 18 patients. 28 Furthermore, Ivey and associates showed that larger kidneys were not only associated with conversion to open surgery with a mass greater than 1500 g, but also had longer operative times and increased blood loss. 29 Some surgeons have attempted strategies to reduce the size of kidneys intraoperatively with bursting of cysts, but this leads to spillage of cystic contents and is associated with increased pain, peritonitis, ileus, and may even be a source of seeding in cases of suspected malignancy.18 More recently however, Bansal and associates, in their series of 39 patients undergoing transperitoneal laparoscopic bilateral nephrectomy in ADPKD with massively enlarged kidneys (mean 1515 g; range, 412-4590 g), had no conversions to open surgery, no excessive blood loss or prolonged operative times.…”

Section: Transplant and Bilateral Nephrectomymentioning

confidence: 99%

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2015

Exp Clin Transplant

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Autosomal dominant polycystic disease is a multisystem inherited condition affecting the kidneys and is an important cause of end-stage renal disease. Patients with autosomal dominant polycystic disease experience symptoms related to size and cystic nature of their kidneys, which can be difficult to manage. Traditionally, the only surgical option for management was open bilateral /unilateral native nephrectomy, which carried with it significant morbidity and mortality. Therefore, it was deemed unsafe and rarely performed.However, surgery for autosomal dominant polycystic disease has evolved rapidly with the advent of minimally invasive surgery and improved medical management of end-stage renal failure patients. Laparoscopic and hand-assisted laparoscopic techniques have been adopted and have demonstrated reduced morbidity. The timing of this intervention in relation to transplant is controversial and presents a major challenge in managing this patient population.

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Limitations of Laparoscopy for Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease

Cited by 68 publications

References 10 publications

Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

Management of Pain in Autosomal Dominant Polycystic Kidney Disease and Anatomy of Renal Innervation

Tailoring the ‘Perfect Fit’ for Renal Transplant Recipients with End-stage Polycystic Kidney Disease: Indications and Timing of Native Nephrectomy

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