Retroperitoneal Laparoscopic Nephrectomy for the Management of Polycystic Kidney Disease

Laparoscopic nephrectomy has become an important surgical strategy in the management of symptomatic autosomal dominant polycystic kidney disease (ADPKD). Indications include chronic pain, recurrent cyst infections, hematuria, early satiety, or respiratory compromise due to massive renal enlargement, and space optimization prior to kidney transplantation. While the transperitoneal approach is more commonly used due to the larger working space it provides, the retroperitoneal approach offers specific advantages in selected cases. Notably, retroperitoneal access avoids intraperitoneal organ manipulation, reducing the risk of bowel injury and postoperative ileus, and is particularly beneficial in patients with a history of previous abdominal surgery. Despite the limited working space and technical difficulty posed by the large size of polycystic kidneys, experienced surgeons can achieve excellent outcomes with retroperitoneal laparoscopic nephrectomy. This approach minimizes peritoneal contamination in infected or hemorrhagic cysts and allows for a direct route to the renal hilum. In expert hands, retroperitoneal laparoscopic nephrectomy is a safe and effective option that contributes to reduced morbidity and faster recovery.