Laparoscopic decortication of symptomatic renal cysts: Experience from a referral center in Iran

Laparoscopic decortication of hilar renal cysts using LigaSure

Background and Objectives:

In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts.

Methods:

Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated.

Results:

The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved.

Conclusion:

Laparoscopic decortication of symptomatic hilar renal cysts—first reported in the literature in this study—using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.

A modified laparoendoscopic single-site renal cyst decortication: single-channel retroperitoneal laparoscopic decortication of simple renal cyst

BACKGROUND

Laparoscopic renal cyst decortication often uses three-port incisions or single-port incision with three or four channels (laparoendoscopic single-site surgery). This article introduces a modified laparoendoscopic single-site surgery for the treatment of simple renal cysts: single-channel retroperitoneal laparoscopic decortication (SCRL) of a simple renal cyst.

PATIENTS AND METHODS

From January 2008 to December 2011, either SCRL or standard three-port-incision retroperitoneal laparoscopic decortication (SRL) was performed for the treatment of a simple renal cyst. The SCRL procedure was as follows. The patients were placed in the lateral decubitus position. A 1.2-cm horizontal skin incision was made over the midaxillary line, 3 cm above the iliac crest. The retroperitoneum working space was established. A 10-mm operative laparoscope, which is similar to a nephroscope, was introduced into the retroperitoneum cavity through a 1.1-cm port. The cyst was exposed and then sutured to help to suspend the cyst wall so that the cyst could be decorticated easily. Perioperative and follow-up data from SCRL and SRL were collected retrospectively.

RESULTS

Based on the cyst location as the major selection criterion, 92 cases were enrolled for further analysis. Of these, 38 patients were treated with SCRL, and 54 patients were subjected to SRL. No SCRL was converted to SRL, and no SRL was converted to open surgery. The operation time and the drain tube removal time in these two approaches were similar (P>.05), but the average duration of hospital stay in the SCRL group was shorter (P=.02). Six months after the surgery, renal ultrasound results showed that the diameter of the cyst in these two groups also had no significant difference (P>.05).

CONCLUSIONS

With appropriate selection of patients, the SCRL approach has the same efficacy with better cosmesis compared with SRL.

Laparoscopic decortication of symptomatic simple renal cyst using conventional monopolar device

In our study, we assessed the efficacy, safety, and feasibility of laparoscopic decortication of symptomatic simple renal cysts using conventional monopolar device. Long-term symptomatic and radiological results of 15 patients who underwent laparoscopic renal symptomatic simple cyst decortication, which was performed by conventional monopolar device, were retrospectively reviewed. The mean age of the patients was 49.7 years. There were nine male and six female patients. Their presenting symptoms were lumber pain in 93% (n=14), and hypertension in 7% (n=1). The mean operating time was 64.6 minutes. The mean hospital stay was 2.2 days. After a mean follow up of 12.08 months, the radiological and symptomatic successes were 100% and 86.6%, respectively. Laparoscopic renal cyst decortication using conventional monopolar device represents an effective and safe treatment option in the management of renal cyst without any need for more expensive energy sources.

'Stepped procedure' in laparoscopic cyst decortication during the learning period of laparoscopic surgery: Detailed evaluation of initial experiences

BACKGROUND

We evaluated the importance and efficacy of 'stepped procedure' in laparoscopic cyst decortication as an initial experience in it.

MATERIALS AND METHODS

A 36 renal cyst cases were included. The stepped retroperitonoscopic cyst excision divided into three groups. First step, doing the incisions to place the ports and expanding the retroperitoneal space with balloon distension, second step, placement of trocars and reach to the cyst, third step, aspiration and decortication of the cyst. The difficulty of the sessions was measured with the Visual Analog Scale (VAS) scoring system. Score was determined according to the difficulty of the surgical step ranging from '0' to '10', '0', too easy, '10' too difficult'. The durations were measured. One-way ANOVA test was used for statistical analysis.

RESULTS

The mean age was 52.0 (20-75) years. The mean operation time was 52.0 min. The mean duration of the first step was 12.5, second, 26.0 and third, 22.5 min. The mean VAS of first step, 3.2, second, 6.0 and third, 3.6 There were only significant differences in duration time and VAS score for second step among the surgeons (P<0.05).

CONCLUSIONS

Laparoscopic cyst decortication may provide gaining experience to approach the kidney laparoscopically. The side, size and localization of cysts were not found associated with the difficulty of the method.