Adult polycystic kidney disease (APCKD) is a hereditary, autosomal-dominant disorder resulting in near complete replacement of normal renal tissue with extensive cystic disease. Bilateral nephrectomy is indicated in APCKD when patients experience abdominal pain from the enlarged kidneys, as well as to make room in the abdomen for renal transplantation. This video demonstrates our hand-assisted, laparoscopic approach to bilateral nephrectomy (HALBN) in a patient with APCKD. The patient is positioned supine with arms extended. A hand port is placed through a periumbilical incision. Two 12 mm trocars are placed lateral to the rectus. Gerota's fascia is opened identifying the renal hilum. The ureter and gonadal vein are divided with an endoscopic stapling device. The renal artery is transected first followed by the vein. The kidney is extracted in a large bowel bag through the hand port. Similar trocars are placed on the contralateral side to extract the other kidney. Despite their large size, kidneys in patients with APCKD can still be removed safely using a HALBN technique.