PKD Open Nephrectomy: Minimally Invasive Tecnique

Abstract

The polycystic kidney disease (PKD) is a genetic disorder with frequent damage of extrarenal organs and systems; functional impairment can lead to end stage renal disease needing for dialysis replacement therapy (hemodialysis or peritoneal dialysis) or both kidney and liver-kidney transplantation. The removal of a polycystic kidney should not be considered common, but necessary if repeated bleeding, recurrent infections and neoplastic degeneration are present or in order to create abdominal suitable space for transplantation. PKD nephrectomy is not a simple surgical procedure because of the size of the mass to remove and frequent adhesions; classic surgical lombotomic extraperitoneal technique often requires a large and invasive access. Intraperitoneal technique, both open and laparoscopic, alters peritoneal integrity, limiting the real possibility of peritoneal dialysis. In order to minimize the invasiveness of the classic open technique a short (10–12 cm) lombotomic incision, with costal preservation and saving the peritoneal integrity, allows to isolate the kidney and then to perform puncture, aspiration and aseptic drainage of targeted renal cysts. Morphological renal remodelling makes possible the removal of the renal mass in limited surgical time and without intra and peri-operative specific complications.