單手輔助式腹腔鏡腎臟切除手術在自體顯性多囊性腎臟病合併巨大腎臟的應用
徐易廷1、薛又仁1,2、黃建榮1、蕭毅君1、賴昱維1,2、邱文祥1,2
1臺北市立聯合醫院仁愛院區 外科部 泌尿科；2國立陽明大學 醫學院 泌尿學科
Application of hand-assisted laparoscopic nephrectomy for huge kidney size in autosomal dominant polycystic kidney disease
Yi-Ting Hsu1, Thomas Y. Hsueh1,2, Andy. C. Huang1, Yi-Chun Hsiao1, Yu-Wei Lai1,2,
Allen W. Chiu1,2
1Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan;
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Background: Laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is technically difficult. Concerning the huge size of these kidneys and perioperative risks, hand-assisted laparoscopic techniques is feasible and thereby assists in nephrectomy. We presented our experience of unilateral hand-assisted laparoscopic nephrectomy via transperitoneal approach.
Presentation of case: The patient was a 43-year-old male diagnosed of ADPKD for 10 years. Owing to progressive renal insufficiency, he initiated hemodialysis since 2018. Computed tomography in July-2020 disclosed polycystic kidney with increased size of renal cysts compared with previous image in 2016. Due to refractory infection and abdominal distension, the patient underwent hand-assisted laparoscopic left nephrectomy via transperitoneal approach. Total operating time was 180 minutes and total blood loss was 50 ml. The patient evolved with an uneventful postoperative period, and was discharged within 7 days postoperatively. The specimen measures 30.0 x 30.0 x 10.0 cm in size and weighs 5500.0 gm.
Conclusions: The hand-assisted laparoscopic approach makes unilateral nephrectomy feasible for huge kidney size in ADPKD patients with acceptable outcome and morbidity.