Laparoscopic-based renal sympathetic denervation for the management of refractory hypertension in patients with end-stage renal disease: A case series of three patients

BACKGROUND: Refractory hypertension is a common and serious complication in patients with end-stage renal disease (ESRD), and conventional medications and catheter-based renal denervation (RDN) have limited efficacy in some patients. Laparoscopic-based renal sympathetic nerve denervation (L-RDN), an emerging noninvasive treatment, may offer new treatment options for selected patients by directly exposing the outer surface of the renal artery for ablation. MATERIALS AND METHODS: This study enrolled 3 patients with ESRD and refractory hypertension who underwent L-RDN. Postoperatively, blood pressure was monitored to assess the changes before and after the procedure, as well as to evaluate the feasibility, safety, and short-term efficacy of this intervention. RESULTS: All 3 patients successfully underwent surgical treatment. Postoperative follow-up revealed that 2 patients completed a full 12-month follow-up, while the remaining patient completed a 6-month interim follow-up. Blood pressure levels in all patients were significantly reduced compared to preoperative levels 1 week after surgery and remained relatively stable throughout the follow-up period. Specifically, the systolic and diastolic blood pressures of the 3 patients decreased by an average of 25 and 21 mmHg, respectively, at 1 week postoperatively, and no significant rebound or fluctuation in blood pressure was observed during the follow-up period. One patient developed a lymphatic fistula 1 month after surgery, which was successfully managed with conservative treatment, while the other 2 patients experienced no significant postoperative complications. This result suggests that the procedure is effective in significantly reducing blood pressure in the short term and may contribute to long-term blood pressure stabilization. CONCLUSION: This case series demonstrates that L-RDN may represent a safe and effective therapeutic modality, offering a potential alternative treatment option for patients with vascular pathologies or contraindications to intravascular interventions. However, given the limited sample size, further prospective studies are necessary to validate its long-term efficacy and safety.