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Purpose: Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder and accounts for 5-10% of all cases of kidney failure. 50% of ADPKD patients reach kidney failure by the age of 58 years requiring dialysis or transplantation. Nephrectomy is performed in up to 20% of patients due to compressive symptoms, renal-related complications or in preparation for kidney transplantation. However, due to the large kidney size in ADPKD nephrectomy can come with a considerable burden. Here we evaluate our institution’s experience of laparoscopic nephrectomy (LN) as an alternative to standard-procedure nephrectomy for ADPKD patients.Materials and Methods: We report the results of the first 12 consecutive laparoscopic cystnephrectomies from 08/2020 to 08/2021 in our institution. Intra- and postoperative parameters were collected and analyzed. Health related quality of life (HRQoL) was assessed using the SF36 questionnaire.Results: Median age of patients was 60 years (±8,1a). Mean preoperative kidney volume measured by volumetric analyzes in abdominal CT scan was 3795ml (range 1255-8253ml). Mean operative time was 158min (range 85-227min). Mean postoperative stay was 11 days (range 6-35 days). Only one postoperative complication Clavien-Dindo ³3 occurred (8,3%). SF36 HRQol questionnaire revealed excellent postoperative quality of life after LN.Conclusion: Laparoscopic nephrectomy in ADPKD patients is a safe and effective operative procedure independent of kidney size with excellent postoperative outcomes and benefits of minimally invasive surgery.

Background: Three-dimensional (3D) stereoscopic vision is crucial to perform any kind of manual tasks. The reduction from real life 3D- to virtual two-dimensional (2D) sight is a major challenge in minimal invasive surgery (MIS). 3D-display technique has shown to reduce operation time, mistakes, and improve the learning curve. Therefore it seems to optimize surgical performance for novice and experienced surgeons. Inspired by consumer electronics 4K display technique was introduced to MIS recently. Due to its high resolution and zoom-effect surgeons should benefit from it. Aim of this study is to evaluate if “state-of-the-art” 3D- versus 4K- display techniques could influence surgical performance. Methods: A randomized cross-over single-institution single-blinded trial is designed. It compares the primary outcome parameter “surgical performance”, represented by “performance time “ and “number of mistakes” using a passive polarizing 3D- and a 4K-display system (2 arms) to perform different tasks in a minimal-invasive/laparoscopic training parkour. Secondary outcome parameters are the mental stress load (NASA task load index) and the learning curve. Unexperienced novices (medial students), non-board certified and board-certified abdominal surgeons participate in the trial (i.e. level of experience, 3 strata). The parkour consists of 7 tasks (novices 5 tasks), which will be repeated 3 times. The 1st run of the parkour will be performed with the randomized display system the 2nd with the other one. After each run metal stress load is measured. After completion of the parkour all participant are evaluated by an ophthalmologist for visual acuity and stereoscopic vision with five tests. A sample-size of 34 per stratum is required to detect a standardized effect of 0.5 with a power of 80% at two-sided type I error of 5%. Thus, altogether 102 subjects need to be enrolled. Discussion: Complex surgical procedures are performed in minimal invasive/laparoscopic technique. This study should provide some evidence to decide which display technique a surgeon could choose to optimize his performance. Trial Registration: This trial is registered at clinicaltrials.gov (trial number: NCT03445429, registered February 7, 2018, http://www.clinicaltrials.gov) Keywords: Minimal invasive surgery, laparoscopic, 3D, 4K, surgical performance, learning curve, surgical training