Context: Indications for laparoscopic renal surgery are increasing; however benefits in adult polycystic kidney disease (APKD) remain uncertain.
Objective: To systematically synthesise the reported literature on safety, feasibility, complications and early outcomes of laparoscopic nephrectomy in APKD to determine clinical benefits for surgical practice.
Evidence Acquisition: We conducted a meta-analysis of the published literature reporting on laparoscopic nephrectomy in APKD between 1991 and 2013. The criteria from the "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) study were used to assess the quality of reported literature.
Results: One prospective and fifteen retrospective studies of low to modest quality (according to the STROBE checklist) were identified, reporting on 293 patients who underwent laparoscopic nephrectomy for APKD. None of the studies was a randomized clinical trial (RCT). Transperitoneal approach was the most commonly used technique. Body mass index ranged from 16 to 57; mean 26.2kg/m2. 53% of patients were dialysis dependent and 31% had a prior or simultaneous transplant. Kidney length ranged from 8 to 50cm (mean 34.5cm), and the mean mass of affected kidneys was 1,647g (range 132g - 7,200g). Duration of hospital stay ranged from 2.6 to 11 days; mean 4.9 days. Operative time ranged from 90-568 minutes, with 16.2% of patients requiring blood transfusion. There were 24 intra-operative complications and 68 post-operative complications, a rate of 8% and 24% respectively. A total of 16 cases (5%) were converted to open technique. No mortality was reported in any of the included studies.
Conclusion: The quality of the included studies is poor, and it is difficult to argue for or against change in clinical practice as the evidence included is of level 3 and 4 only. Higher quality studies are needed to demonstrate that the technique is generalizable across all populations.
Written by:
Williamson A, Paterson S, Erolin C, Sweeney C, Townell N, Nabi G. Are you the author?
University of Dundee, Department of Urology, Dundee, United Kingdom.
Reference: J Endourol. 2014 Jul 7. Epub ahead of print.
doi: 10.1089/end.2014.0311
PubMed Abstract
PMID: 24999965
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