HOW I DO IT The Canadian Journal of Urology; 13(6); December 2006 Accepted for publication June 2006 Address correspondence to Dr. Anil Kapoor, McMaster University, Institute of Urology, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique Saleh Binsaleh, MD, 1 Patrick P. Luke, MD, 2 Christopher Nguan, MD, 2 Anil Kapoor, MD 1 1 Division of Urology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada 2 Division of Urology, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada BINSALEH S, LUKE PP, NGUAN C, KAPOOR A. Comparison of laparoscopic and open nephrectomy for adult polycystic kidney disease: operative challenges and technique. The Canadian Journal of Urology. 2006;13(6):0000-0000. Objectives: Autosomal dominant polycystic kidney disease an inherited systemic disorder is characterized by the development of multiple cysts in the kidneys and other organs. When nephrectomy is indicated, the laparoscopic approach is challenging due to the massive size of these kidneys. We present our technique and evaluate the surgical outcomes of laparoscopic versus open nephrectomy for patients with such condition. Materials and methods: A retrospective review was done for six laparoscopic and six open nephrectomies performed by two laparoscopic surgeons in two university hospitals between January 2004 and December 2004. Preoperative, intraoperative, and postoperative data are presented. A standard subcostal incision was used for the open cases while for the laparoscopic approach a 3-4- port transperitoneal laparoscopic approach was used to dissect the involved kidney, which is then removed intact or morcellated through pfannenstiel, midline, or expanded port site incision. Results: The laparoscopic patients had a longer operative time with one major complication compared to the open group. On the other hand laparoscopic group achieved minimal blood loss, less narcotic requirement and a shorter hospital stay. No conversion to open required in the laparoscopy group. At a median follow up of 1 year no long-term complications reported in either groups. Conclusions: Laparoscopic nephrectomy for polycystic kidney disease is a feasible and safe alternative to open approach. In addition to low morbidity, other advantages of laparoscopic surgery also achieved in this subset of patients such as the ability to remove the dissected kidney through a small incision, reduced postoperative pain, short hospital stay, and excellent cosmesis. Key Words: laparoscopy, polycystic kidney, nephrectomy, minimally invasive worldwide, and is the fourth most common cause (approximately 10%) of all cases of end stage renal disease. 1 ADPKD patients manifest with several other associated anomalies that include cysts in the liver, pancreas, spleen, and lungs; aneurysms of the circle of Willis (Berry aneurysms) are responsible for death in 8% to 11% of patients with ADPKD. 2 Mitral valve prolapse and colonic diverticula are some of the other anomalies seen in these patients. Mutations in the PKD1 or PKD2 genes give rise to cyst formation. Affected individuals can present at any age, but more often come to clinical attention (unless there is a family history) after age thirty. Patients who are Introduction Autosomal dominant polycystic kidney disease (ADPKD), an inherited systemic disorder, is characterized by the development of multiple cysts in the kidneys and other organs. It affects approximately four to six million individuals 3034