Minimally Invasive Nephrectomy for the Management of Polycystic Kidney Disease: The Hilum-First Technique

<b>Background:</b> Nephrectomy in patients with polycystic kidney disease (PKD) is typically arduous due to the considerable size of the kidneys. The laparoscopic method has arisen as a minimally invasive substitute for open surgery. Nonetheless, conventional laparoscopic methods may be inadequate for tackling the distinct anatomical complexities of a large polycystic kidney. This study presents a unique method, "the hilum first technique", specifically designed for nephrectomy in patients with PKD, emphasizing its safety and efficacy in addressing this intricate condition. <b>Methods:</b> A retrospective analysis of patients with PKD who underwent minimally invasive nephrectomy using "the hilum first technique" at our hospital between 2020 and 2025. Data on operative time, blood loss, conversion rates, hospital stay, and outcomes were analyzed to evaluate this technique's safety and efficacy. <b>Results:</b> Minimally invasive nephrectomy using the "hilum first technique" was successfully performed in 16 cases; the mean age of patients was 56.3 years. Two of which were robot-assisted, in which one of them, a bilateral nephrectomy was done, with no conversions to open surgery, even for huge kidneys. The mean operative time was 159.6 min, with an estimated blood loss of 50 mL. Postoperatively, the median duration of hospital stay was 4 days (range: 3-10 days), and 75% of patients experienced no complications. Three patients (18.7%) were readmitted within 30 days due to surgical site infection, subcutaneous hematoma, and pneumonia. Seven patients (43.7%) underwent kidney transplantation within a median duration of 132 days post-nephrectomy. <b>Conclusions</b>: This retrospective study, although limited by a small sample size, demonstrated significant promise as a novel strategy for tackling the challenges of huge polycystic kidneys. The findings suggest its feasibility and safety, although further validation is required.