Robot-assisted Synchronous Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease: a Stepwise Description of Technique.

ABSTRACT Objective : To describe our technique of robot-assisted synchronous bilateral nephrectomy (RASBN) for autosomal dominant polycystic kidney disease (ADPKD). Methods : Given prior abdominal surgery/transplant in most patients, we prefer an open cut-down access to place a 12mm port 10cm infra-umbilically. Four (8mm) robotic ports are then placed under vision in a fan distribution along the umbilical level. The operating table is placed in reverse Trendelenburg and tilted opposite to the targeted side. Provided there are no concerns for malignancy, some cysts encountered in large kidneys (>2.5L) may require puncture, to facilitate access and mobilization. The resected kidney is placed in a large bag and tucked in the pelvis. A similar procedure is carried out on the contralateral side after redocking the robot and tilting the table in the opposite direction. The specimen bags are extracted by elongating the lower midline 12mm port site. Results : Seven cases of RASBN performed for ADPKD were identified (December 2015 to December 2018). Median (Interquartile range, IQR) values for patient demographics were: Age=59yrs (47-63), Body Mass Index=29 (26-32), and American Society of Anaesthesiology grade=3. Three patients had prior Deceased- and four had prior Living- Donor Transplants. Indication for nephrectomy were: Pain (5), Hemorrhage into cysts (3), and Renal masses (2). Perioperative outcomes were: Operating Room time=388mins, Estimated Blood Loss=200mL, Hemoglobin change=1.3g/dL, Transfusion=0, Length of hospital stay=3days, Grade I Clavien-Dindo complications=2cases. All patients were alive at a median follow-up of 3.8yrs. Conclusions : RASBN is safe and effective in ADPKD even in the context of prior renal transplant patients with attendant comorbidities.