Modified Supine Hand Assisted Laparoscopic (HAL) bilateral nephrectomy for Autosomal Dominant Polycystic Kidney Disease (ADPKD): A Step-by-Step technique

Abstract Introduction Autosomal Dominant Polycystic Kidney Disease(ADPKD) is a genetic disorder characterized by development of multiple renal cysts. Significantly enlarged cysts can encroach on anatomical space required for future renal transplantation and frequently cause recurrent infective and haematuria episodes throughout the patient's lifetime. This presentation aims to present the step-by-step surgical technique of modified supine hand assisted laparoscopic (HAL) bilateral nephrectomy for ADPKD in our series of 8 consecutive patients, as well as its advantages. Materials From May 2016 to October 2020, a total of 8 patients who underwent HAL bilateral nephrectomy for ADPKD, by a single surgeon, was retrospectively evaluated in this study. A step-by-step HAL bilateral nephrectomy technique is as follows: (1) Modified supine positioning, (2) Midline GelPort® (Applied Medical) creation, (3) 10 × 12 mm upper midline and lumbar ports insertion for camera and working instruments, (4) Nephrectomy, (5) Operating team and equipment re-positioning, (6) Contralateral nephrectomy. The specimen can be extracted via the same incision for the hand-port, facilitating quick recovery with minimal post-operative pain and excellent cosmesis. Patient demographics, peri‐ and postoperative short-term outcomes were analysed. Results 8 HAL bilateral nephrectomies were performed. Median operative time was 250 mins (IQR 182-230). Mean length of stay was 4 days (s=1.2 days) with a median blood loss of 200 millilitres (IQR 50 – 250 millilitres). Mean VAS analogue score on post-operative day 1 (POD) was 2.8 (s=1.4). The mean combined weight on histology was 3167g (s=1179g). Adrenal glands were preserved in all patients. There were no open conversions, no vascular or bowel injuries, with no grade 3 and above modified Clavien-Dindo classification complications. Conclusions HAL bilateral nephrectomy for ADPKD is a safe and feasible technique which provides good postoperative outcomes with limited risk of complications while ensuring cosmetic satisfaction.