Limits...
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.

Abraham GP, Siddaiah AT, Das K, Ramaswami K, George DP, Thampan OS - J Minim Access Surg (2015 Jul-Sep)

Bottom Line: 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.Technical modifications with increasing surgeon's experience allows successful conductance of this approach in more complex cases with better outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.

ABSTRACT

Context: 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.

Aims: 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).

Settings and design: Retrospective.

Materials and 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.

Statistical analysis used: 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.

No MeSH data available.


Related in: MedlinePlus

Intraoperative image (a) port positions with morcellator inserted (b) morcellated specimen (c) appearance at procedure completion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4499924&req=5

Figure 1: Intraoperative image (a) port positions with morcellator inserted (b) morcellated specimen (c) appearance at procedure completion

Mentions: Initial port positions were similar. However in large kidneys, additional ports (1 or 2 additional working ports) were utilized to facilitate dissection. A special multifunctional laparoscopic hook suction irrigation equipment (Ethicon Endopath Probe Plus II, Ethicon Endosurgery, Johnson and Johnson) that allows simultaneous hook electrocautery and suction-irrigation was used. Cysts hindering satisfactory dissection were deflated by puncturing with the hook electrocautery followed by immediate suction of the cyst contents with the same instrument. Identification and division of the ureterogonadal pedicle was performed first. The divided ureter was used as a fulcrum and dissection was continued cranially to gain entry to the renal hilum. Vascular control was achieved. After nephrectomy completion, a morcellator (Gynecare, Ethicon, Johnson and Johnson) was introduced by converting the 10 mm right hand working port (towards iliac fossa) to 12 mm port [Figure 1a]. Nephrectomy specimen was held by a forceps and morcellated taking care to avoid iatrogenic complications [Figure 1b]. Thorough peritoneal toileting was conducted following morcellation. Drain placement, port closures were undertaken [Figure 1c].


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.

Abraham GP, Siddaiah AT, Das K, Ramaswami K, George DP, Thampan OS - J Minim Access Surg (2015 Jul-Sep)

Intraoperative image (a) port positions with morcellator inserted (b) morcellated specimen (c) appearance at procedure completion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499924&req=5

Figure 1: Intraoperative image (a) port positions with morcellator inserted (b) morcellated specimen (c) appearance at procedure completion
Mentions: Initial port positions were similar. However in large kidneys, additional ports (1 or 2 additional working ports) were utilized to facilitate dissection. A special multifunctional laparoscopic hook suction irrigation equipment (Ethicon Endopath Probe Plus II, Ethicon Endosurgery, Johnson and Johnson) that allows simultaneous hook electrocautery and suction-irrigation was used. Cysts hindering satisfactory dissection were deflated by puncturing with the hook electrocautery followed by immediate suction of the cyst contents with the same instrument. Identification and division of the ureterogonadal pedicle was performed first. The divided ureter was used as a fulcrum and dissection was continued cranially to gain entry to the renal hilum. Vascular control was achieved. After nephrectomy completion, a morcellator (Gynecare, Ethicon, Johnson and Johnson) was introduced by converting the 10 mm right hand working port (towards iliac fossa) to 12 mm port [Figure 1a]. Nephrectomy specimen was held by a forceps and morcellated taking care to avoid iatrogenic complications [Figure 1b]. Thorough peritoneal toileting was conducted following morcellation. Drain placement, port closures were undertaken [Figure 1c].

Bottom Line: 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.Technical modifications with increasing surgeon's experience allows successful conductance of this approach in more complex cases with better outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Lakeshore and PVS Memorial Hospital, Kochi, Kerala, India.

ABSTRACT

Context: 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.

Aims: 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).

Settings and design: Retrospective.

Materials and 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.

Statistical analysis used: 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.

No MeSH data available.


Related in: MedlinePlus