BACKGROUND
Autosomal dominant polycystic kidney disease (ADPKD) is frequently associated with massive kidney enlargement, which complicates kidney transplantation by limiting intra-abdominal space. Simultaneous bilateral nephrectomy with kidney transplantation can reduce surgical burden and avoid staged procedures, but it is technically demanding and rarely performed using robotic surgery. No such cases have been reported previously in Asian patients.
CASE REPORT
Two adult patients with end-stage kidney disease due to ADPKD presented with severe abdominal distension, pain, early satiety, and impaired quality of life caused by massively enlarged kidneys extending into the pelvis. Robot-assisted simultaneous bilateral nephrectomy was performed using a transperitoneal approach, followed by living-donor kidney transplantation during the same operation. Despite distorted anatomy, limited working space, and extensive vascular adhesions, robotic nephrectomy allowed precise dissection and safe completion of bilateral kidney removal. After repositioning, graft implantation in the iliac fossa was successfully achieved. Operative times were prolonged (approximately 10 hours and 9 hours), reflecting the complexity of simultaneous bilateral nephrectomy and transplantation, while estimated blood loss remained low and no transfusions were required. Both patients demonstrated immediate graft function, early ambulation, and uneventful recovery without intraoperative or postoperative complications.
CONCLUSIONS
Robot-assisted simultaneous bilateral nephrectomy with kidney transplantation is feasible and safe in selected patients with severely enlarged polycystic kidneys. These first reported Asian cases suggest that this approach may offer perioperative and recovery advantages while avoiding the risks of staged operations.

Keywords: Case Reports; Postoperative Recovery; Robotic Surgical Procedures; Surgical Procedures, Operative; Transplantation