Laparoscopic management of symptomatic simple renal cysts

Objective: To evaluate the efficacy of retroperitoneoscopy for the treatment of symptomatic renal cyst disease. Patients and methods: We evaluated the efficacy and morbidity of aspiration versus open and laparoscopic surgical techniques in a paired institution over a 20-year period. Prospectively recorded parameters for the 11 cases dealt with by primary retroperitoneoscopic techniques were compared with historical controls dealt with by open surgery. Results: Small volume cysts were satisfactorily dealt with by aspiration alone. All patients undergoing laparoscopic cyst decortication for the larger volume cysts had a satisfactory outcome with improvement in their symptoms and objective cure on follow up imaging studies. Conclusion: Laparoscopic management for all cysts is a safe, effective and minimally invasive alternative to open surgery for symptomatic renal cysts. Simple drainage under radiological guidance is also highly effective and should probably be first line treatment for cysts up to 6 cms in diameter whereas primary laparoscopic treatment should be suggested for larger cysts. This revised version was published online in August 2006 with corrections to the Cover Date.     

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.     

Laparoscopic unroofing of symptomatic congenital liver cysts

Background: Unroofing is the therapy of choice in patients with symptomatic, nonparasitic benign liver cysts—either solitary or diffuse. Techniques which require laparotomy, such as cystojejunostomy or pericystectomy, generally do not justify surgical morbidity in benign conditions. Methods: We report the outcome of eight fenestration operations in seven patients with hepatic cysts in laparoscopic performance. Patients were reexamined after a mean follow-up period of 30 months. Results: All operations were finished without conversion. There were no perioperative complications. Only one patient had a recurrence and was successfully reoperated via laparoscopy including cholecystectomy without refilling of the cyst until reexamination. Conclusions: Adoption of minimal access surgery in these patients occurred without loss of quality and offered the well-known benefits of laparoscopic surgery.     

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.     

Laparoscopic excision of a large symptomatic and kidney-displacing adrenal myelolipoma: A case report

Introduction

Adrenal myelolipoma is a rare tumor. Traditionally, open surgical adrenalectomy was the standard treatment for symptomatic myelolipoma. However, laparoscopic excision is a promising alternative approach.

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.     

Percutaneous treatment of large symptomatic renal cysts

PURPOSE: To evaluate the efficacy of alcohol in combination with tetracycline for the treatment of symptomatic renal cysts. PATIENTS AND METHODS: Twenty-four patients age 45 to 77 years (mean 66 years) with a large (5-13-cm; mean 7.5-cm) symptomatic renal cyst associated with flank pain were treated by aspiration under ultrasound guidance and injection of alcohol and tetracycline. Patients were followed with ultrasonography at 1, 6, and 12 months and once a year thereafter. RESULTS: The aspirated volume ranged from 65 to 1500 mL (mean 360.5 mL). Two patients experienced mild pain during alcohol injection, but the procedure was completed successfully. One patient reported severe pain after tetracycline injection. The tetracycline was immediately aspirated, and the procedure was then aborted. The remaining patients were relieved of their symptoms after treatment, and they remained symptom free during a mean follow-up of 20 months (range 7-36 months). CONCLUSIONS: The combination of alcohol and tetracycline is safe and effective and offers a very favorable minimally invasive therapeutic alternative for the treatment of symptomatic renal cysts.     

Surgical management of adrenal cysts

Adrenal cysts are rare and are often found incidentally during abdominal imaging for another reason. We describe two cases of adrenal cysts, one of which was found to be a cystic pheochromocytoma. Most cystic pheochromocytomas are not diagnosed by urinary screening studies, and the first indication of a pheochromocytoma may be hemodynamic instability during resection. We review the literature on adrenal cysts and make recommendations for the management of cystic adrenal masses.     

腹腔镜手术治疗肾上腺囊肿

目的 总结腹腔镜手术治疗肾上腺囊肿的经验.方法 肾上腺囊肿患者32例.囊肿位于左侧17例,右侧14例,双侧1例.囊肿直径平均6.4(3.5～14.5)cm,其中直径＜4.0 cm者3例,4.0～8.0 cm者25例,＞8.0 cm 4例.均行腹腔镜下肾上腺囊肿切除术,其中经腹途径5例,经腹膜后途径27例.对手术适应证、手术时间、术中出血量、术后住院时间等进行比较分析.结果 32例手术均获成功.5例经腹途径者囊肿直径平均(9.5±3.1)cm,手术时间(65.0±12.1)min,出血量(37.2±10.1)ml,术后平均住院时间(4.4±0.7)d;27例经腹膜后途径者分别为(5.8±1.2)cm、(43.3±6.4)min、(23.1±7.6)ml、(3.3±0.6)d;2组以上参数比较差异均有统计学意义(P＜0.05).32例术后平均随访28(2～60)个月,均未复发.结论 经腹腔和腹膜后途径手术治疗肾上腺囊肿各有优势,对于囊肿体积偏小、无明显粘连者采取经腹膜后途径更安全,操作更便捷.     

Laparoscopic management of hepatic cysts

The present study describes the technique and evaluation of postsurgical results, hospital stay, and follow-up of patients who underwent hepatic cyst surgical treatment by laparoscopic access. Twelve patients presenting liver cystic disease were included in this research. Clinical conditions, laboratorial and radiologic examinations, surgical technique, complications, and postoperative follow-up were discussed. In our series, the morbidity rate was 25%. No mortality was observed in the postoperative period. Conversion to open surgery was necessary in 1 case, owing to hemorrhage. No recurrence was found and patients remain asymptomatic in their current follow-up. Laparoscopic resection of hepatic cyst proved to be efficient in the regression of the cysts and resulted in disappearance of symptoms.     

Laparoscopic management of symptomatic multiple hepatic cysts: a combination of deroofing and radical excision.

BACKGROUND: Liver cysts have been estimated to occur in 5% of the population. Multiple liver cysts can also be part of the polycystic disease complex. Only symptomatic or complicated cysts need surgery. Traditionally, laparotomy is the procedure of choice. We present our experiences with laparoscopic management of both symptomatic multiple liver cysts and polycystic liver disease. METHODS: Between 1995 and 2006, we treated 12 patients with large, multiple liver cysts, including 4 cases of polycystic liver disease. Most of the patients were elderly males. The lung and other organs were not involved in any case. Laparoscopic deroofing or radical excision with omentoplasty was successfully performed in these patients. RESULTS: Postoperatively, 4 patients had fluid draining through the drainage tube for an average of 10 days. One patient had ascites that resolved spontaneously. Cysts recurred in 5 patients. DISCUSSION: There are not many reports in the literature regarding large series of patients, further confirming the rarity of the disease. Liver cysts can occur as a part of polycystic renal and lung disease or isolated to the liver alone. Laparoscopic deroofing is the ideal treatment for nonpolycystic liver disease, and laparoscopic radical excision is ideal for polycystic liver disease. Simple needle aspiration or sclerotherapy is inadequate as recurrence is almost 100%. CONCLUSION: Currently, laparoscopy scores over laparotomy for the treatment of nonparasitic liver cysts as evidenced by this and other studies.     

Laparoscopic resection of large adrenal ganglioneuroma

We report on a 23-year-old woman with a right adrenal tumor 13 cm in diameter who was treated by laparoscopy. The patient was asymptomatic, and the tumor was incidentally diagnosed on abdominal ultrasonography. A subsequent computed tomography (CT) of the abdomen confirmed a 12 x 7 x 8-cm homogenous mass of the right adrenal. Magnetic resonance imaging (MRI) showed a solid mass measuring 13 x 7 x 7.5 cm arising from the right adrenal. Laparoscopic complete excision of the mass was accomplished through a transabdominal lateral approach. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. Histology was consistent with an adrenal ganglioneuroma. Two years later, there is no evidence of recurrence on abdominal CT scan.     

Laparoscopic resection of large adrenal tumors

Background The maximum size of adrenal tumors that should be removed with a laparoscopic approach is controversial. It has been suggested that laparoscopic adrenalectomy is appropriate only for adrenal tumors <6 cm in size. We report our experience with laparoscopic adrenalectomy in patients with adrenal tumors of ≥6 cm compared with patients with smaller tumors. Methods We retrospectively reviewed a consecutive series of patients who had a laparoscopic adrenalectomy. Patients were considered candidates for laparoscopic adrenalectomy if their computed tomography (CT) scan showed a well-encapsulated tumor confined to the adrenal gland. Results Sixty laparoscopic adrenalectomies were performed in 53 patients. Twelve of the adrenalectomies (20%) were for tumors that were ≥6 cm (median, 8 cm; range, 6 to 12 cm). There have been no local or regional recurrences but one patient with adrenocortical carcinoma developed pulmonary metastases. When the 12 patients with large tumors were compared with the 36 patients with tumors <6 cm, the median operative time (190 vs. 180 minutes;P=.32), operative blood loss (100 vs. 50 mL;P=.53), and postoperative hospital stay (2 vs. 2 days;P=1.0) were similar. Conclusions The size of an adrenal tumor should not be the primary factor in determining whether a laparoscopic adrenalectomy should be performed. Large adrenal tumors that are confined to the adrenal gland on CT can be removed with a laparoscopic approach.     

Surgical management of symptomatic simple hepatic cysts

The authors present three cases of symptomatic, large, benign, nonparasitic hepatic cysts. The diagnosis was determined by US and CT scan, the latter enabling differential diagnosis with neoplastic or hydatid cysts. All patients were treated with open hepatic resection. In 2 cases, laparoscopy was performed to enable complete diagnosis. The authors used LigaSure? (Covidien, USA) instrument, avoiding bleeding complications and reducing surgery time. Histological examination confirmed the diagnosis of benign cysts. CT follow-up at 6 months and 1 year demonstrated the efficacy of the surgery, with no recurrences.     

Surgical management of symptomatic pineal cysts.

The authors present a series of six patients with large symptomatic benign pineal cysts and review the 27 patients previously reported in the literature. Patients with symptomatic pineal cysts most often present with one of three syndromes: 1) paroxysmal headache with gaze paresis; 2) chronic headache, gaze paresis, papilledema, and hydrocephalus; or 3) pineal apoplexy with acute hydrocephalus. Surgical intervention with radical cyst removal is the treatment of choice for all symptomatic pineal cysts. Complete cyst removal is desirable; however, radical subtotal resection is appropriate if the cyst cannot be easily separated from the quadrigeminal plate. Ventricular shunting should be reserved for patients with persistent hydrocephalus after cyst resection.