Experience with laparoscopic management of solitary symptomatic splenic cysts

Aggressive laparoscopic procedures can be used to manage pathologic lesions of solid organs. We attempted laparoscopic management of solitary symptomatic splenic cysts in four patients--two men and two women--ranging in age from 19 to 63 years (mean, 35 years). The cysts involved the whole spleen in one case, the upper pole in one, and the lower pole in two. We performed laparoscopic splenectomy in one case and laparoscopic unroofing of the cyst wall in three. In two procedures we successfully used needlescopic instruments. The duration of surgery and the volume of intraoperative bleeding were 300 minutes and 200 mL, respectively, for the splenectomy, and an average of 170 minutes (range, 120-240) and minimum volume, respectively, for the unroofing. There were no intra- or postoperative complications related to the laparoscopic procedures. The postoperative hospital stay was 9 days for the patient who underwent splenectomy and an average of 5.6 days (range, 5-7) for the patients who underwent unroofing. Laparoscopic management of splenic cysts is technically feasible and safe and has the advantages of reduced postoperative pain, shortened convalescence, and improved cosmesis.     

Laparoscopic treatment of nonparasitic hepatic cysts

Background We present our experience with laparoscopic deroofing of nonparasitic hepatic cysts. Methods Laparoscopic deroofing was performed due to a solitary hepatic cyst in 21 patients and polycystic liver in four patients. Laparoscopy was indicated when a cyst was larger than 5 cm (the general size of cysts was 6.9 cm) and caused complaints and was in a superficial position. In eight patients in whom the cyst was larger than 10 cm, omentoplasty was performed. Results Intraoperative complications were not detected. Two conversions were performed because of the deep position of the cyst. Postoperative bile leakage was detected in one case that was treated conservatively. The average hospital stay was 4.7 days. Relapse occurred in two patients (8%), but only one of them required a second operation. Conclusions We recommend laparoscopic deroofing for treatment of nonparasitic liver cysts. This operation causes only slight discomfort for the patients, the intra- and postoperative morbidity is low, and relapses are rare.     

Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.     

Tailoring the management of nonparasitic liver cysts.

OBJECTIVE: To determine the optimal management of symptomatic non-parasitic liver cysts. SUMMARY BACKGROUND DATA: Management options for symptomatic nonparasitic liver cysts lack substantiation through comparative studies with respect to safety and long-term effectiveness. METHODS: A retrospective review of the surgical management of patients with hepatic cysts between October 1988 and August 1997 was undertaken to determine morbidity rates and to assess long-term recurrence. RESULTS: Thirty-eight patients (35 women, 3 men) underwent 48 operations for symptomatic hepatic cysts of mean diameter 12 cm, with a mean follow-up of 41 months. Twenty-three patients had simple cysts, and 15 patients had polycystic liver disease (PCLD). The symptomatic recurrence rates after laparoscopic or open deroofing for simple cysts were 8% and 29%, and for PCLD 71% and 20%, respectively. There were no symptomatic recurrences after 14 hepatic resections. There were no perisurgical deaths; however, morbidity rates were significant after laparoscopic deroofing, open deroofing, and hepatic resection (25%, 36%, and 50%, respectively). CONCLUSIONS: Selection of patients with truly symptomatic hepatic cysts is crucial before considering interventional techniques. For simple cysts, radical laparoscopic deroofing is usually curative; open deroofing should be reserved for cysts inaccessible by laparoscopy. The latter technique is well tolerated; however, long-term symptom control is unpredictable in patients with PCLD. Hepatic resection for PCLD provides satisfactory long-term symptom control but has an appreciable morbidity rate. Although laparoscopic and open deroofing procedures are less reliable in the long term for solitary cysts, they might be useful steps before embarking on this major procedure.     

Long-term results after laparoscopic unroofing of solitary symptomatic congenital liver cysts

Background: Reports about laparoscopic management of symptomatic nonparasitic liver cysts are increasing, proving the procedure feasible and safe. However, late results of endoscopic unroofing currently are not available. The primary aim of the study was to offer long-term results with a follow-up of more than 5 years. Two diagnostic pitfalls are presented. Methods: Preoperatively, diagnosis was established by sonography, computed tomography (CT) scan, echinococcus serology, and tumor-marker measurement. The outcome of 12 laparoscopic fenestrations in 11 patients with symptomatic solitary liver cysts is presented. Nine patients were reexamined after a median observation time of 3.1 years (range, 0.6–6.4 years) by clinical investigation and ultrasonography, CT scan, or magnetic resonance imaging (MRI), respectively. Results: All operations could be finished laparoscopically, and no death occurred. Simultaneous cholecystectomy was performed in six cases. All patients experienced immediate relief of symptoms. Postoperatively, no complications were observed except one patient with unilateral brachial vein thrombosis. Histologically, we discovered one hydatide cyst and one cystadenoma underlying the cystic disorder leading to further therapy. At follow-up, one of the remaining seven patients (14.3%) suffered symptomatic recurrence and successfully underwent reoperation endoscopically. Conclusions: The results of this study confirm the outcome reported previously after short- and intermediate-term follow-up showing that laparoscopic management of symptomatic solitary nonparasitic liver cysts is permanently successful in a large majority of cases when diagnosis is correct. Received: 16 July 1998/Accepted: 17 December 1998     

Laparoscopic fenestration of symptomatic liver cysts

The purpose of this clinical study was to evaluate the usefulness of laparoscopic fenestration of symptomatic liver cysts. Between September 1996 and September 2001, 6 patients underwent laparoscopic fenestration for symptomatic hepatic cysts. All 6 patients were women. The mean age was 59.5 (range 40-74). Two patients had single and 4 had multiple cysts. The mean diameter of the lesions, measured by preoperative computed tomography (CT), was 16.8 cm (range 10-20). The indications for surgical treatment included abdominal fullness associated with pain or dyspepsia. The surgical procedure involved puncture and aspiration of the cyst and subsequent circular electroresection of the cystic wall. Laparoscopic fenestration was successfully done in all 6 patients. The operating time was 148 minutes (range 110-215). Mean blood loss was 93 mL (range 5-300). Histologic examination of the cyst wall showed 5 simple cysts and 1 papillary serous cystadenoma. There were no intraoperative or postoperative complications. The mean hospital stay after surgery was 4.3 days (range 3-5). Complete relief of symptoms was achieved in 5 patients during the postoperative follow-up (range 2-6 years, mean 4). Follow-up CT (1 month to 4 years) has shown regression of the cysts in all patients (mean 3.8 cm, range 2-8). Laparoscopic fenestration of symptomatic liver cysts is a simple and effective method to relieve symptoms with minimal surgical trauma.     

Simple surgical treatment of nonparasitic hepatic cysts.

Benign nonparasitic liver cysts are uncommon lesions. Incidental diagnosis is increasing with the advent of routine abdominal computed tomography and ultrasound scanning. Cysts that attain massive proportions often become symptomatic and require therapeutic intervention. Surgical resection and Roux-en-Y cystojejunostomy drainage have been the treatments of choice, but simpler unroofing techniques without drainage have recently been employed with success. Three patients with symptomatic, large, nonparasitic cysts were surgically treated in such a fashion without complication and form the basis of this report. The technique of wide unroofing involves excision of the nonhepatic cyst wall with oversewing of communicating biliary radicals. No recurrences have been detected in follow-up screening. Wide unroofing is a simple and yet reliable surgical option for the treatment of symptomatic hepatic cysts.     

Nonparasitic cysts of the liver. The case for conservative surgical management.

The recommended treatment for nonparasitic hepatic cysts (NPHC) has been either resection or drainage into a Roux loop of jejunum. From 1970-1984 a more conservative approach to NPHC was adopted in 22 patients with large symptomatic cysts. Seventeen patients were treated with simple unroofing without complication. By comparison, two of three patients treated by Roux-en-Y drainage developed infected hepatic cysts that required subsequent surgical drainage. Patients treated by external drainage without unroofing or hepatic resection had either cyst recurrence or complications. In conclusion, wide unroofing is the treatment of choice for NPHC even when the cyst fluid is bile stained.     

Sclerosant therapy as first-line treatment for solitary liver cysts

AIM: The aim was to determine the outcome from percutaneous sclerosing treatment of solitary non-parasitic hepatic cysts. METHODS: The results of treatment of patients with symptomatic solitary non-parasitic hepatic cysts treated between 1995 and 2000 were reviewed. RESULTS: There were 23 women and one man with a median (range) age of 59 (34-79) years. The median (range) diameter of the cysts was 10 (5-24) cm. Five patients were treated by laparoscopic fenestration ab initio as they also required a cholecystectomy because of gallstones. The remaining 19 patients underwent percutaneous sclerotherapy. In one just aspiration was successful without further treatment. In six contrast leaked from the cyst and five of these had laparoscopic fenestration. Twelve patients had sclerosant treatment with good results at a median (range) follow-up of 35 (6-60) months in 10 patients. Good results were also obtained in 10 of the 12 patients who had fenestration.     

Laparoscopic management of benign cystic lesions of the liver

We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31 patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size of the solitary liver cysts was 14 cm (range, 7–22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control bleeding. The median operative time was 141 min (range, 94–165 min) for patients with PLD and 179 min (range, 88–211 min) for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1–3 days), 3 days (range, 2–7 days), and 5 days (range, 2–17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range, 3–78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999     

Recurrence after laparoscopic excision of nonparasitic splenic cysts

Background

Minimally invasive treatments for nonparasitic splenic cysts are well described. Recent evidence suggests that laparoscopic splenic cystectomy is associated with high recurrence rates in children. Because these cysts are uncommon, no large series is available. We reviewed our clinical data focusing on cyst recurrences and their management.

Methods

All children who underwent laparoscopic excision of a nonparasitic splenic cyst from January 2002 to December 2006 were identified. Medical and surgical records were reviewed for perioperative details, hospital course, and outcome.

Results

Eight children (median age, 13 years; range, 7-16 years) who underwent laparoscopic splenic cystectomy were identified. The most common presenting complaint was left upper quadrant pain or mass (n = 6; 75%). Median cyst size was 13 cm (range, 4-20 cm). There were no conversions to an open technique, completion splenectomies, or perioperative complications. Cysts were identified pathologically as epidermoid (n = 6) or posttraumatic (n = 2). Median hospital stay was 1.5 days. One child required partial splenectomy because of cyst anatomy and remains recurrence-free at 12 months. Cyst recurrence occurred in 7 patients (88%) at a median of 9.4 months (range, 3-18 months) after initial surgery. Median recurrent cyst size was 5.6 cm (range, 3-11 cm). Of 7 recurrences, 4 (57%) were symptomatic. Percutaneous ultrasound-guided cyst drainage and sclerosis were performed in 2 children with symptomatic recurrences, one of whom required 4 separate interventions. There were no complications during management of cyst recurrences. Five children with recurrence (71%) have been followed conservatively and are free of morbidity at a median of 23 months (range, 8-55 months).

Conclusions

Laparoscopic excision of nonparasitic splenic cysts in children is associated with a high recurrence rate and may be insufficient treatment. Partial splenectomy may decrease recurrence rates. Conservative management of splenic cyst recurrence after laparoscopic excision is associated with good short-term outcomes. If necessary, image-guided management of symptomatic recurrences can be performed safely.     

Laparoscopic ablation of symptomatic peripelvic renal cysts

PURPOSE: We report our experience with laparoscopic ablation of symptomatic peripelvic renal cysts. PATIENTS AND METHODS: Two men and two women (mean age 58) with a peripelvic renal cyst associated with ipsilateral flank pain and obstruction were treated by transperitoneal laparoscopic ablation. One patient had an episode of pyelonephritis before detection of the cyst. Cyst size ranged from 4.5 to 6.5 cm (mean 5.5 cm). Dissection of the cyst was intricate because of the close proximity to the renal hilum and the compressed collecting system. Patients were followed with radiologic imaging at 6 and 12 months and once a year thereafter. RESULTS: In all cases, the laparoscopic procedure was successful. The operative time ranged from 120 to 190 minutes (mean 155 minutes), and the mean blood loss was <150 mL. The mean postoperative hospital stay was 2.7 days (range 2-5 days), and the time of convalescence was 14 days. Complications consisted of a subcutaneous hematoma. At a mean follow-up of 23 months, symptoms and collecting system obstruction had resolved in all patients. CONCLUSION: Although laparoscopic ablation of peripelvic renal cysts is technically challenging, it is a safe and efficacious procedure and offers a favorable minimally invasive alternative for the treatment of symptomatic cysts.     

A ten-year experience with laparoscopic treatment of splenic cysts.

BACKGROUND AND OBJECTIVES: The management of symptomatic splenic cysts lacks clear, evidence-based guidelines due to its low incidence. Recently, laparoscopic treatment has been described. We present our experience with the laparoscopic management of solitary splenic cysts with a review of the existing literature, and recommendations for therapy. METHODS: All patients who underwent laparoscopic treatment of splenic cysts over a 10-year period were identified. The medical records of these 9 patients were reviewed. RESULTS: All surgeries were performed laparoscopically, with no conversions. Two patients underwent cyst decapsulation, and 7 patients underwent cyst unroofing. No major complications occurred. Recurrence occurred in 33.3% of patients; unroofing had a recurrence rate of 42.9% compared with 0% after decapsulation. Pseudocysts were found in 66.7% of patients and true cysts on final pathology were found in 33.3%. CONCLUSIONS: Laparoscopic decapsulation and unroofing of splenic cysts are safe procedures that confer the advantages of both splenic preservation and minimally invasive surgery. Cyst unroofing has a high recurrence and should be selectively used. Laparoscopic cyst decapsulation is associated with longer operative time, but should be considered as first-line therapy.     

闭合式经后腹腔镜腔镜肾囊肿去顶

OBJECTIVE: To study the close method of retroperitoneal laparoscopic unroofing of renal cyst. METHOD: A close method retroperitoneal laparoscopic unroofing of renal cyst was attempted in 35 cases between May 1995 and December 1996. The age of the patients ranged from 30 to 72 and the cyst size from 4.0 to 9.3 cm. RESULTS: The operative procedure took around 50 minutes. After a 1 - 18 month follow up, we observed the disappearance of all renal cysts. CONCLUSION: The laparoscopic procedure renders less trauma and discomfort to the patients and may be better indicated for symptomatic, simple renal cysts.     

腹腔镜治疗非寄生虫性脾囊肿3例附文献复习

目的:探讨腹腔镜治疗非寄生虫性脾囊肿的可行性.方法:2007年7月至2010年7月为3例脾囊肿患者行腹腔镜脾囊肿去顶减压术,用超声刀切开囊壁,完全暴露囊腔,在囊壁与正常脾脏组织交界0.5cm处切除囊壁,并直接取出.结果:3例均成功完成腹腔镜脾囊肿去顶减压术,无一例中转开放手术.手术时间分别为45min、30min、35...     

Laparoscopic unroofing of nonparasitic liver cysts within segments VII and VIII: technical considerations

BACKGROUND: The laparoscopic accessibility of congenital liver cysts located in the anterosuperior (VIII) and posterosuperior (VII) segments has been questioned for some time. In support of the laparoscopic approach, we here describe our minimally invasive technique in two patients with solitary congenital cysts located in the apex of liver segments VIII and VII, respectively. METHOD: Both patients were placed in the inverted Y position. Four trocars were used, their position depending on the location of the cyst. RESULTS: The segment VIII cyst was easily reached via this anterior approach, while the segment VII cyst required significant mobilization of the right liver lobe. In both cases a complete excision of the cystic roof was achieved using the harmonic scalpel. Without performing an omentoplasty no recurrences were observed after 20 and 28 months, respectively. CONCLUSION: Solitary cysts located in segments VII and VIII of the liver can be safely treated by laparoscopic unroofing. Cyst recurrences may best be prevented by a complete excision of the cystic roof with an adjacent rim of hepatic parenchyma.     

Management and long-term follow-up of hepatic cysts.

PURPOSE: To provide an algorithm for the management of hepatic cysts through an analysis of our series over 16 years. METHOD: We reviewed the surgical management and outcome of patients with hepatic cysts between 1984 and 2000 at a single institution. Data were collected by chart review, telephone interview, and follow-up hepatic ultrasonography. RESULTS: Forty-four patients (36 females, 8 males) underwent a total of 46 operations for hepatic cysts (mean size 12.0 +/- 5.2 cm) with a mean follow-up of 5.1 +/- 4.0 years. We treated 28 simple cysts, 4 polycystic liver disease (PCLD), 7 cystadenomas, 2 hydatid cysts, 1 cystadenocarcinoma, 1 endometrioma, and 1 hepatic foregut cyst. Operations included simple drainage, wide unroofing (open and laparoscopic), and hepatic resection. Four patients experienced a symptomatic recurrence after definitive treatment; 3 of these patients had PCLD. Four of the 7 patients with cystadenomas had undergone previous operations that required subsequent definitive resection without a recurrence. CONCLUSIONS: The preoperative distinction between simple cysts and cystadenomas/cystadenocarcinomas can be difficult, yet the management is different. Unroofing is a safe and effective operation for patients with simple cysts. Patients with PCLD frequently have recurrences. Cystadenomas should be completely resected owing to the likelihood of recurrence after partial excision and the risk of eventual cystadenocarcinoma. We present a treatment algorithm for the preoperative evaluation and management of hepatic cysts based on the largest number of patients with the longest follow-up reported to date.     

Large cystic lesions of the liver in adults: a 15-year experience in a tertiary center.

BACKGROUND: Cystic lesions of the liver consist of a heterogeneous group of disorders and may present a diagnostic and therapeutic challenge. Large hepatic cysts tend to be symptomatic and can cause complications more often than smaller ones. STUDY DESIGN: We performed a retrospective review of adults diagnosed with large (> or = 4 cm) hepatic cystic lesions at our center, over a period of 15 years. Polycystic disease and abscesses were not included. RESULTS: Seventy-eight patients were identified. In 57 the lesions were simple cysts, in 8 echinococcal cysts, in 8 hepatobiliary cystadenomas, and in 1 hepatobiliary cystadenocarcinoma. In four patients, the precise diagnosis could not be ascertained. Mean size was 12.1 cm (range, 4 to 30 cm). Most simple cysts were found in women (F:M, 49:8). Bleeding into a cyst (two patients) and infection (one patient) were rare manifestations. Percutaneous aspiration of 28 simple cysts resulted in recurrence in 100% of the cases within 3 weeks to 9 months (mean 4(1/2) months). Forty-eight patients were treated surgically by wide unroofing or resection (laparoscopically in 18), which resulted in low recurrence rates (11% for laparoscopy and 13% for open unroofing). Four of the eight patients with echinococcal cysts were symptomatic. All were treated by open resection after irrigation of the cavity with hypertonic saline. There was no recurrence during a followup period of 2 to 14 years. Hepatobiliary cystadenomas occurred more commonly in women (F:M, 7:1) and in the left hepatic lobe (left:right, 8:0). Seven were multiloculated. All were treated by open resection, with no recurrence, and none had malignant changes. Cystadenocarcinoma was diagnosed in a 77-year-old man, and was treated by left hepatic lobectomy. CONCLUSIONS: Large symptomatic simple cysts invariably recur after percutaneous aspiration. Laparoscopic unroofing can be successfully undertaken, with a low recurrence rate. Open resection after irrigation with hypertonic saline is a safe and effective treatment for echinococcal cysts. Hepatobiliary cystadenomas have predilection for women and for the left hepatic lobe. Malignant transformation is an uncommon but real risk. Open resection is a safe and effective treatment for hepatobiliary cystadenoma, and is associated with a low recurrence rate.     

Open and laparoscopic treatment of nonparasitic splenic cysts

BACKGROUND: Nonparasitic splenic cysts are rare. Therefore, there is no 'evidence-based' information regarding their optimal surgical management. In the last years the laparoscopic approach has gained increasing acceptance in splenic surgery. The aim of this study is to present our experience with the laparoscopic management of splenic cysts. METHODS:The medical records of 7 patients with splenic cysts were reviewed retrospectively. RESULTS: One patient had an open partial splenic resection. Five patients, 3 of them with a posttraumatic and 2 with an epidermoid splenic cyst, underwent laparoscopic unroofing of the cyst. In 4 of these cases the postoperative course was uneventful, whereas in 1 case the patient developed a cyst relapse soon postoperatively. Later on this patient successfully underwent an open partial splenic resection. The 7th patient had an explorative laparoscopy. The cyst was located intrasplenically, entirely covered with unaffected splenic parenchyma, and reached the splenic hilus. Therefore, a conversion to open partial splenectomy was performed. CONCLUSION: Open partial splenectomy and laparoscopic cyst wall unroofing are both effective tools in the management of splenic nonparasitic cysts. Surgeons must master both techniques as nowadays spleen-preserving techniques should be attempted in every case of splenic nonparasitic cyst.     

Laparoscopic management of benign solid and cystic lesions of the liver

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.