Retroperitoneoscopic Nephrectomy at the Time of Kidney Transplantation for Autosomal Dominant Polycystic Kidney Disease: Safety, Efficacy, Feasibility, and Cosmetic Outcomes

Background. Autosomal dominant polycystic kidney disease (ADPKD) leads to end-stage kidney disease, necessitating kidney transplantation (KTx). Native nephrectomy is required when polycystic kidneys are too large to be safely implanted into the iliac fossa. Open nephrectomy (ON), requiring a large skin incision to remove large polycystic kidneys, is a highly invasive procedure. Simultaneous retroperitoneoscopic nephrectomy (RN) with KTx has not been previously documented; therefore, we aimed to evaluate the safety and efficacy of RN during KTx in comparison with those of ON. Methods. Nineteen consecutive ADPKD kidney recipients, around 50 y old, were enrolled. RN was performed in 11 recipients, and ON in 8 recipients. We compared the perioperative outcomes and early complications between the 2 procedures. Results. No differences were observed in patient backgrounds. The total operative time, intraoperative blood loss, and removed kidney weight were similar between the groups. The oblique muscles were significantly more atrophic on the nephrectomy side in the ON group than in the RN group (atrophy of muscle thickness ratio to the contralateral side measured by postoperative computed tomography, 24% and 2%, respectively; P = 0.003). Conclusions. RN, when performed simultaneously with KTx, is safe, well-tolerated, less invasive, and cosmetically advantageous compared with ON for ADPKD >1 y post-surgery.