Purpose: We describe our experience with simultaneous bilateral laparoscopic radical nephrectomy
performed in patients with acquired cystic kidney disease (ACKD) and renal tumors.
Materials and Methods: Between June 2000 and September 2002, 10 patients with ACKD underwent
simultaneous bilateral laparoscopic radical nephrectomy for renal lesions suspicious for carcinoma.
The lesions were discovered during pretransplant evaluation in 9 patients and incidentally
in 1 renal transplant recipient. A 3- or 4-port transperitoneal approach was used for each side to
mobilize the kidney and secure the renal hilum. Both specimens were extracted through a midline
supraumbilical incision. Operative time, blood loss, analgesic requirements, hospital stay, and convalescence
and recurrence rates were determined.
Results: The mean age of the patients was 41.6 years (range, 29–47 years). Mean operative time
was 6.5 hours (range, 4.5–9.7 hours) and mean estimated blood loss was 164 cc (range, 50–300 cc).
There was one intraoperative complication—a clotted arteriovenous (AV) graft; and 2 postoperative
complications—1 fluid overload and 1 adrenal insufficiency. The average length of hospital stay
was 3.1 days (range, 2–4 days) and mean convalescence was 2.8 weeks (range, 1–6 weeks). All cancers
were confined to the kidneys and there has been no recurrence during follow-up ranging from
6 to 26 months.
Conclusion: Bilateral laparoscopic radical nephrectomy in end-stage renal disease patients is safe
and feasible. The advantages of the laparoscopic approach include minimal intraoperative blood
loss, shorter hospital stay, minimal postoperative pain, and a rapid return to normal activity. The
laparoscopic technique offers an effective, minimally invasive therapeutic alternative to open surgery
in high-risk end-stage renal disease patients.
