Laparoscopic decortication of symptomatic simple renal cysts: 10-year experience from one institution

OBJECTIVE: To assess the long-term results by symptomatic and radiological outcome of laparoscopic decortication of renal cyst, first reported in 1992. PATIENTS AND METHODS: We retrospectively reviewed the records of 36 patients who had a total of 36 laparoscopic decortications at our institution between December 1993 and March 2004. Of these cysts, 30 were peripheral and six were peripelvic cysts; the patients were asked if they had pain or not. Changes of cyst size after decortication were determined by computed tomography and the serial changes of each cyst were evaluated as the percentage of the diameter before surgery. The relationships between radiological and symptomatic outcome or cyst location were examined. RESULTS: Peri-operative morbidity was satisfactory; with a mean (range) follow-up of 67.2 (13-128) months the symptomatic and radiological success rates were 92% (33 of 36) and 81% (25 of 36), respectively. Peripelvic cysts were significantly correlated with radiological failure. Symptomatic improvement was evident by 3 months, while radiological improvement continued for up to 3-4 years after surgery. Seven asymptomatic patients with radiological failure selected a conservative follow-up. CONCLUSIONS: Laparoscopic decortication is safe and provides long-term satisfactory symptomatic results. The radiological improvement was slower than the symptomatic improvement and several cysts remained large, indicating some reduction in volume that was enough to improve the symptoms. This procedure is still challenging for peripelvic cysts in terms of radiological results, yet feasible for the clinical outcome.     

Laparoscopic ablation of peripelvic renal cysts

Recently, laparoscopic surgery has been reported for symptomatic renal cysts. A 60-year-old female was referred to Toyama Medical and Pharmaceutical University Hospital with a chief complaint of general fatigue and left back pain. CT demonstrated bilateral peripelvic renal cysts, and DIP demonstrated left hydronephrosis and a medical shift of the left renal pelvis. Laparoscopic ablation of bilateral peripelvic renal cysts was performed under general anesthesia and a round excision was made in the cyst wall via the peritoneum. After surgery, the left back pain disappeared and CT demonstrated resolution of peripelvic renal cysts. Laparoscopic ablation of peripelvic renal cyst is a highly effective and minimally morbid procedure.     

Retroperitoneoscopic decortication of symptomatic renal cysts

PURPOSE: To determine the safety and efficacy of retroperitoneoscopic decortication of symptomatic renal cysts. PATIENTS AND METHODS: A total of 24 patients with symptomatic 6- to 14-cm (mean 10.9-cm) simple renal cysts, right sided in 13 and left sided in 11, underwent retroperitoneoscopic decortication for pain relief at our center between January 1997 and December 2002. The diagnosis was based on an ultrasonogram and contrast-enhanced CT. Symptom severity, assessed using a visual analog pain scale, averaged 7.2/10 (range 6.5-9). The mean duration of symptoms was 4 months. Operative and follow-up data were collected prospectively and analyzed for symptomatic and objective evidence of improvement. RESULTS: The mean operating time was 95 minutes, and no major complications were observed. The average hospital stay was 2.9 days (range 2-7 days). At a mean follow-up of 2.8 years (range 1.5-5 years), pain relief was reported by 22 patients (change of pain score from 7.2 to 1.4). One patient had worsening of pain at 6 weeks postoperatively. Asymptomatic recurrence of the cyst was seen in two patients on the follow-up ultrasound scans. CONCLUSIONS: Retroperitoneoscopic renal-cyst decortication is a safe, minimally invasive, and efficacious procedure for the treatment of painful renal cysts, with a durable response.     

Laparoscopic decapsulation of congenital splenic cysts: a step forward in splenic preservation

Purpose

The aim of this study was to evaluate the role of laparoscopic decapsulation in the management of congenital splenic cysts in children.

Methods

Patients who presented over the last decade with congenital splenic cysts and were treated with laparoscopic decapsulation were reviewed retrospectively. The authors performed 4 procedures in 3 patients aged 10, 11 (and later 13), and 13 years. In all cases there was progressive enlargement of a single cyst, which lay in the upper pole of the spleen in 3 instances and in the lower pole in the fourth. Pneumoperitoneum was induced using the Veress needle technique, and 3 or 4 ports were utilized. Cysts were aspirated initially before marsupialization with excision of around two thirds of the cyst wall. Both endoshears and the harmonic scalpel were used with good hemostatic effect.

Results

All patients had a good outcome with cyst resolution on long-term follow-up using serial ultrasound scanning. The first patient (in 1993) remained 3 days as an in patient postoperatively, and the others stayed overnight only. One patient had a new cyst near the first 30 months after the initial procedure. This again was dealt with laparoscopically, with patient discharge the following day. There were no complications in the short or long term. Histology in all cases confirmed a simple epithelial cyst. Median follow-up was 2 years (range, 6 months to 8 years).

Conclusions

Our experience shows that laparoscopic decapsulation is an effective means of managing congenital splenic cysts and that both harmonic scalpel and endoshears are satisfactory dissecting instruments. Extensive marsupialization is probably unnecessary in these larger cysts, because long-term follow-up has shown no increased risk of recurrence after leaving a significant proportion of the cyst wall behind. This approach helps avoid major surgery in these cases.     

腹腔镜治疗肾囊肿16例

目的 探讨腹腔镜手术治疗单纯性肾囊肿疗效。方法 采用经腹腔和经腹膜后腹腔镜技术对16例单纯性肾囊肿行囊肿去顶术,并回顾分析比较20例开放性肾囊肿去顶术。结果 经腹腔途径手术时间与开放手术无显著性差异(P>0.05),经腹膜后途径手术时间显著长于开放手术(P<0.05),腹腔镜手术患者的术中失血量、术后并发症及术后住院时间均显著少于开放手术(P<0.01)。结论 腹腔镜肾囊肿去顶术具有创伤小、术后并发症少及康复快等优点,治疗单纯性肾囊肿的疗效明显优于开放性手术。     

Retroperitoneal laparoscopic decortication of simple renal cysts using the bipolar PlasmaKinetic scissors

OBJECTIVES: To analyse the efficacy, safety and feasibility of retroperitoneal laparoscopic decortication of simple renal cysts using bipolar PlasmaKinetic scissors. METHODS: Records of 19 patients who underwent laparoscopic decortication of simple renal cysts, performed with bipolar PlasmaKinetic scissors without additional fulguration of the base or the margin of resection, were retrospectively reviewed. Long-term symptomatic and radiological outcomes were assessed. RESULTS: One single cyst was treated in fourteen (73.7%) cases, two cysts in three (15.8%) cases, three cysts in one (5.2%) case and multiple cysts in one case with autosomal dominant polycystic kidney disease. They were peripherally located in thirteen, peripelvic in three, and parenchymal in two cases. An average of 3.1 trochars were used for each procedure. The mean operating time was 82.5 +/- 16.7 min (range, 50-135). Neither open conversion nor blood transfusion was necessary. A total of six minor complications were encountered. Mean hospital stay 2.3 +/- 0.9 days (range, 1-4). After a mean follow up of 14.3 +/- 5.9 months (range, 3-24), symptomatic success was achieved in 89.5%, and radiological success was accomplished in 88.2%. An asymptomatic cyst recurrence was observed in one (5.9%) case, and one (5.9%) case with residual pain had new cyst formation at another site of the kidney. CONCLUSIONS: Retroperitoneal laparoscopic cyst decortication using bipolar PlasmaKinetic scissors is a feasible and efficient method, eliminating further fulguration of the base and the margins of the cysts. Operating times are shorter than previously published series and highly satisfactory long-term success rates are achieved.     

Laparoscopic renal biopsy: a 9-year experience

OBJECTIVES: To present our experience and outcome of consecutive laparoscopic renal biopsy over a 9-year period, as renal biopsy remains an important diagnostic procedure for evaluating proteinuria, haematuria and renal failure, but when percutaneous biopsy is contraindicated, a laparoscopic biopsy is an attractive option because it is minimally invasive. PATIENTS AND METHODS: Seventy-four patients (29 male, 45 female, mean age 45 years, range 3-79) had a laparoscopic renal biopsy taken for various indications, e.g. morbid obesity, solitary kidney, coagulopathy, failed percutaneous biopsy, high location of the kidney and poor visualization with ultrasonography. The kidney was approached via a laparoscopic retroperitoneal route using a two-port technique, with the patient in the flank position. After identifying the kidney, one to five cortical biopsies were obtained with cup-biopsy forceps. RESULTS: Adequate tissue was obtained in 96% of the patients; the mean (range) operative duration was 123 (9-261) min and the estimated blood loss 67 (5-2000) mL. Forty-three patients were discharged within 24 h. Complications occurred in 10 patients, with significant bleeding in three. One patient died after surgery, secondary to a perforated peptic ulcer while on high-dose steroid therapy. CONCLUSION: Laparoscopic renal biopsy is a safe and effective alternative to open renal biopsy for patients in whom percutaneous biopsy is not feasible. It offers the advantage of obtaining cortical biopsies and achieving haemostasis under direct vision. Adequate renal tissue is obtained in most cases. Recovery and convalescence are short for most patients.     

改良的二孔腹腔镜肾囊肿开窗术

目的：探讨改良的二孔腹腔镜法在肾囊肿开窗术中的运用、推广价值.方法：分析运用改良的二孔腹腔镜法行肾囊肿开窗术患者的临床资料30例.手术方法：取腋中线髂棘上2横指偏腹侧小切口,长约1.5～2.0 cm（a孔）,手指内推腹膜,在手指引导下取腋后线12肋缘下（b孔）置0.5 cm套管.0.5 cm套管和1.0 cm套管分别从8号手套食指和中指穿过,和手套一起进入a孔,将手套的手腕部分反盖在a孔周围,予手术皮肤贴膜将手套的手腕部分紧贴在患者腰部皮肤.常规游离肾囊肿表面,行囊肿开窗术,从b孔取出标本,a孔放置引流管.结果：手术时间10～35 min,平均25 min;术后住院2～4天,平均3天.随访时间2～3个月,未出现相关并发症.结论：使用普通的腹腔镜器械进行改良二孔腹腔镜肾囊肿开窗术是安全可行的,伤口美观,效果良好.并且在此熟练的基础上可以同样开展其他后腹腔手术,具有推广运用价值.     

直接闭合式经腹膜后腹腔镜肾囊肿去顶术治疗肾囊肿

目的 探讨直接闭合式经腹膜后腹腔镜肾囊肿去顶术治疗效果. 方法 1996年12月～2003年9月,我院采用直接闭合式方法经腹膜后腹腔镜肾囊肿去顶术治疗肾囊11例.腰部髂嵴上2 cm腋中线交界处做小切口1～2 cm,深度至皮下组织,10 mm trocar直接穿刺进入后腹腔,自制注水气囊扩张腹膜后间隙,充分暴露肾囊肿,距离肾实质边缘0.5～1.0 cm处电刀切除囊壁. 结果 10例手术获得成功,手术时间30～100 min,平均77.5 min.术中出血量20～60 ml,平均30.9 ml.1例因暴露囊肿困难中转开放性手术.1例腹膜损伤.术后住院6～9 d,平均7.4 d.7例随访7～26个月,平均15.2月,B超检查肾囊肿无复发. 结论 直接闭合式经腹膜后腹腔镜肾囊肿去顶术创伤小、恢复快、疗效可靠.     

Treatment of symptomatic simple renal cysts by percutaneous aspiration and ethanol sclerotherapy

OBJECTIVE: To report our experience with the use of 95% ethanol as sclerotherapy for symptomatic simple renal cysts. PATIENTS AND METHODS: Sixty patients with 64 symptomatic simple renal cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of 95% ethanol (31 men and 29 women, mean age 46 years, SD 22). The main presentation was renal pain in 34 patients, renal mass in nine, hypertension in 11 and haematuria in six; 24 cysts were on the right, 32 on the left and four bilateral. Patients were evaluated after 1 month and then every 6 months by clinical assessment, US and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume with the resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume and/or persistent symptoms. RESULTS: After aspiration and ethanol sclerotherapy, there was microscopic haematuria in two patients and low-grade fever (<38.3 degrees C) in two, but no major complications. During a mean (range) follow-up of 19 (14-40) months there was complete cyst ablation in 54 cysts and partial resolution in 10. Pain disappeared or was much improved in all patients. After cyst ablation hypertension was well controlled with no medication in all 11 hypertensive patients and haematuria disappeared in all six affected patients. CONCLUSIONS: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive and highly effective. We recommend it as the first therapeutic option in these patients.     

单孔腹腔镜肾囊肿去顶术与传统腹腔镜手术的对比研究

目的比较单孔腹腔镜与传统腹腔镜肾囊肿去顶术的手术效果,总结单孔腹腔镜肾囊肿去顶术的手术经验。方法自2010年1月至2011年3月,我院收治单纯肾囊肿患者30例,随机分为两组,其中采用自制单孔多通道腹腔镜肾囊肿去顶术15例,传统腹腔镜手术去顶术15例,所有手术均为同一位外科医师主刀,比较两组的手术时间、术中出血量及近期随访手术疗效。结果 30例手术均获成功,两组术中均无明显并发症发生。传统腹腔镜与单孔腹腔镜在手术时间(63.5minvs52.5min,P=0.104)、术中出血量(20mlvs25ml,P=0.721),术后住院时间(4.3dvs4.9d,P=0.647)无统计学差异。结论在取得一定腹腔镜手术经验的单位,单孔多通道腹腔镜是安全可行的,其与传统腹腔镜肾囊肿去顶术相比,并不明显增加手术时间。     

Laparoscopic management of ovarian dermoid cysts: ten years' experience.

OBJECTIVE: To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. METHODS: Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. RESULTS: Ninety-three dermoid cysts with a mean diameter of 4.5 cm were removed in 81 patients. Operative techniques used were cystectomy for 70 cysts, salpingooophorectomy for 14, and 9 salpingo-oophorectomy with hysterectomy. Fifty-three cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve. Twenty-two were treated via enucleation and removal within an impermeable sack. Nine were treated via enucleation and removal by posterior colpotomy. Nine were removed via colpotomy following hysterectomy. We had a total of 39 spillages. Spillage rates varied with removal method: 32 (62%) for trocar removal without an endobag, 3 (13.6%) for removal within an endobag, and 4 (40%) with colpotomy removal. No spillage occurred for the nine patients who had a colpotomy done for hysterectomy. Mean hospital stay after surgery was 0.98 days, and there were no intraoperative complications. In one case, there was a postoperative complication of an incisional infection in the umbilicus. CONCLUSION: Including this and 13 other studies, review of the literature reveals a 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Thus, we conclude that laparoscopic management of dermoid cysts is a safe and beneficial method in selected patients when performed by an experienced laparoscopic surgeon.     

腹腔镜开窗引流术治疗儿童非寄生虫性脾囊肿的单中心经验

目的:探讨腹腔镜下开窗引流术治疗儿童非寄生虫性脾囊肿的应用价值。方法:回顾分析2017年5月至2020年5月为6例脾囊肿患儿行腹腔镜脾囊肿开窗引流术的临床资料,统计分析囊肿大小、患儿年龄、手术时间、术中出血量、腹腔引流管留置时间及术后住院时间等相关指标,并进行长期随访,观察复发及并发症等情况。结果:6例患儿均成功完成腹腔镜脾囊肿开窗引流术,无中转开腹。患儿4~15岁,手术时间75~150 min,术中出血量10~30 mL,术后留置腹腔引流管4~19 d,术后住院4~19 d。术后随访0.5~3年,2例复发。结论:腹腔镜下脾囊肿开窗引流术治疗儿童脾囊肿安全、可行,操作简单。     

后腹腔镜肾囊肿去顶术与开放性手术的比较

目的　比较后腹腔镜肾囊肿去顶术与开放手术的优越性。方法　采用后腹腔镜行肾囊肿去顶 36 例,并回顾性分析比较31例开放性肾囊肿去顶术。结果　腹腔镜手术用时20~75 min,平均45 min,术后恢复快。对比开放手术,腹腔镜手术的手术时间、术后并发症及术后住院时间均明显减少。结论　后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿的疗效明显优于传统开放性手术,值得推广。     

腹膜后腹腔镜肾囊肿去顶术65例报告

目的:总结腹膜后腹腔镜肾囊肿去顶术的手术经验。方法:回顾分析2004年8月至2011年6月为65例患者行腹膜后腹腔镜肾囊肿去顶术的临床资料。其中男44例,女21例;28～77岁,平均53岁。结果:65例均顺利完成腹膜后腹腔镜手术,无一例中转开放。64例行肾囊肿去顶术,1例改行腹腔镜肾部分切除术。手术时间30～120 min,平均42 min。患者均未输血。术中、术后无明显并发症发生。65例患者均获随访,随访3～60个月,行B超或CT检查,均无囊肿或肿瘤复发。结论:腹膜后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿安全、有效,值得推广应用。     

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.