Autosomal dominant polycystic kidney disease (ADPKD) is considered one of the most common genetic disorders. Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disorder, which usually manifest during third and fourth decade of life with varied symptomatology notably abdominal pain, urinary tract infection, hematuria and hypertension. A large number of patients along with ADPKD finally present with end-stage renal disease [ESRD] requiring renal replacement therapy. Nephrectomy is often mandated in patients with ADPKD and ESRD. Recurrent infection, pain, hematuria non-respondent to conservative measures and large kidney that interferes with satisfactory graft placement remain the most common reasons.
PROCEDURE:
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A 4 port procedure was adopted. First port (10 mm) is placed pararectal roughly two fingerbreadths cranial & 2 fingerbreadths lateral to the umbilicus. Initial access was acquired by open technique (Hasson trocar).
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Other 10 mm port was introduced into the right of the first port at one point approximately midway in between umbilicus & ipsilateral anterior superior iliac spine. 2 additional ports (one 5 mm port left to the first port and other 5 mm port in ipsilateral flank is also inserted) After colonic reflection, entry is gained into the Gerotas fascia plane & renal mobilization were conducted along this plane. Harmonic scalpel and hook electrocautery were used variably to facilitate the dissection and control the oozing. Much no. of cysts of different sizes & contents were generally encountered in these cases that will completely distort the renal anatomy.
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Cysts hindering dissection & approach to real hilum were punctured by using a hook electrocautery. This cyst contents are instantly aspirated by performing a laparoscopic suction. Recurring alike sequence of steps was undertaken deflating the innumerable obstructing cysts.
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Afterward renal hilum was entered and the renal artery was delineated and securely control. A careful search was done for additional arteries which are usually coexist in these cases. After secured arterial control, attention is focused to the control over renal vein.
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Based on the titanium metal clips, arterial caliber or hem-o-loc clips are used for arterial occlusion where in all cases vein were occluded by using 10 mm hem-o-loc clips. No vascular stapler is employed in any case.
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After hilar control, ureter is secured control. Upper pole & posterior dissection is then completed followed by the nephrectomy completion. Hemostasis was make sure and from intraperitoneal toileting is conducted by using copious antibiotic mixed irrigant.
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Nephrectomy specimen is extracted by extension the right hand working port. A wide bore drain is inserted in all cases. A port and retrieval site closure was then commence.
