Laparoscopic Cyst Excision Research Articles

Laparoscopic Mucosectomy for Large Choledochal Cyst

The laparoscopic excision of the choledochal cyst is feasible, but it entails certain difficulties while dealing with huge cysts because of the risk of injury of important surrounding structures. Mucosectomy of these large cysts is described in open surgery for huge adherent cysts, and the idea can be applied for laparoscopic excision. Over a period of 5 years, 5 of 30 patients with a large choledochal cyst underwent the laparoscopic mucosectomy. The procedure was done under general anesthesia, with an initial operative cholangiography to delineate the anatomy of the cyst. The common hepatic duct at its junction with the cyst was dissected and cut, leaving the distal end attached to the cystic duct and gallbladder. The cyst was opened at its upper part, and the upper half with the attached gallbladder was excised en block. A plane between the mucosa and the covering of the cyst was found, and the mucosa was peeled by traction and countertraction with proper hemostasis. The procedure was completed by performing hepatico-duodenostomy. Five patients were operated on by this technique. Their age ranged from 3 months to 8 years. The procedure was done successfully in all patients, but a conversion was needed in 1 patient due to a difficult hepatico-duodenostomy. The operative time ranged from 125 to 180 minutes (mean, 140). The follow-up ranged from 4 months to 5 years, with a relief of symptoms in all cases and with no evidence of cholangitis or jaundice. Mucosectomy can be performed safely with the laparoscopy. The technique is easy, avoiding the difficult dissection of the huge adherent cyst from the surrounding important structures.

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 and Perineal Excision of an Infected “Dumb-Bell” Shaped Retrorectal Epidermoid Cyst

Extraperitoneal cysts in the pelvis adjacent to the rectum are rare entities. They are of vague etiology, and the pathologic types of the acquired variety are dermoid, epidermoid, and teratoma. As far as we know, laparoscopic excision of a retrorectal epidermoid cyst has never before been reported. The patient was an elderly lady with a large pelvic cyst and another large cyst in the perineum, which displaced the vagina and the anus. Laparoscopy was performed; the pelvic cyst was punctured and then dissected out. The perineal extension of the cyst was excised via a perineal approach. The patient had an uneventful recovery and was discharged on the 4th postoperative day. Histopathologically, the cyst was of the epidermoid type. Follow-up after 26 months revealed no recurrence. Our case presented a diagnostic dilemma. Laparoscopic excision was tedious, though we completed the procedure successfully. Precaution was taken to avoid spillage of the contents and also to avoid injury to vital structures nearby, such as the iliac vessels and ureter. It is feasible to laparoscopically excise retrorectal cysts with a careful and meticulous dissection. The major advantages are rapid recovery with minimal morbidity and excellent cosmesis.

Laparoscopic excision of extraprostatic ejaculatory duct cyst

Our experiences with laparoscopic excisions of symptomatic extraprostatic ejaculatory duct cysts (EDCs) are reported. Three laparoscopic excisions of extraprostatic EDCs performed by one urologist in 2003 and 2004 were retrospectively reviewed. Investigations included history, physical examination, image analysis, semen analysis, operation time, estimated blood loss, time of post-operative hospital stay, recovery time for regular activities, sexual function and complications. The laparoscopic excisions of EDCs were successful. The mean operation time was 105 min, and the mean estimated blood loss was 65 ml. The average post-operative hospital stay was 3.0 days. All patients exhibited normal erection and normal ejaculation. Improvement in semen quality was observed in two patients. All patients remained free of symptoms, and recurrence of EDCs was not detected on transrectal ultrasonography over a mean 32-month follow-up period. It is concluded that laparoscopic excision of an EDC is feasible and effective. Due to minimal invasiveness, short post-operative hospitalisation and rapid recovery, laparoscopic surgery is an attractive approach to managing symptomatic EDCs, especially for sizeable cysts or those including calculus.

Laparoscopic excision of a large ovarian cyst

Laparoscopic excision of a large ovarian cyst

Multiple antenatally diagnosed foregut duplication cysts excised and the value of thoracoscopy in diagnosing small concurrent cysts

A case report of a female neonate referred with antenatally diagnosed cystic lesions within the right hemithorax and under the left hemidiaphragm is presented to highlight the ease with which these lesions can be resected in an asymptomatic post-natal infant with minimally invasive surgery. The diagnostic and cosmetic benefits of minimally invasive surgery are also demonstrated. While excising the documented thoracic cyst, another small cyst was identified adherent to the right main bronchus. An elective laparoscopic excision of the abdominal cyst was also successful. A brief review of the complications and treatment of foregut duplication cysts is detailed.

Laparoscopic excision of a giant ovarian cyst after ultrasound-guided drainage

The laparoscopic approach to giant ovarian cysts in pediatric population may be difficult regarding the risk of cyst rupture and limited working space. We herein report a 16-year-old adolescent girl that presented with a giant ovarian cyst. To reduce the limitations of the laparoscopy, we performed laparoscopy after draining the cyst under ultrasonographic guidance. Under local anesthesia, a nephrostomy catheter was placed into the cyst by the Seldinger technique. During laparoscopy, abdominal cavity was explored by the scope and then the nephrostomy catheter was removed. Laparoscopic procedure was completed easily. No pre- and postoperative complications were encountered and the patient was discharged on the second postoperative day. The pathologic examination of the cyst revealed as follicular cyst. Laparoscopic excision of giant ovarian cysts after ultrasound-guided drainage seems to be safe and applicable treatment modality in children.

Laparoscopic excision of seminal vesicle cyst revealed by obstruction urinary symptoms

Primary diseases of the seminal vesicle are rare. Most seminal vesicle cysts are congenital, and two-thirds are associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. Acquired cysts may be due to genitourinary infections, surgical prostate resection or ejaculatory duct lithiasis. We report a case of video laparoscopic ablation of seminal vesicle cysts.

Does laparoscopic removal of nonendometriotic benign ovarian cysts affect ovarian reserve?

The objective of this study was to investigate whether laparoscopic excision of nonendometriotic benign ovarian cysts is associated with a significant injury to ovarian reserve. Women selected for IVF-ICSI cycles who previously underwent laparoscopic excision of a monolateral nonendometriotic benign ovarian cyst were retrospectively identified. The operated ovary and the contralateral intact gonad of the same patient were compared in term of basal ovarian volume before initiating ovarian stimulation and number of dominant follicles at the time of human chorionic gonadotropin administration. Non-parametric Wilcoxon Rank test was used to investigate differences between the two ovaries. Seventeen cases were recruited. The numbers of dominant follicles were 4.6 +/- 2.5 and 2.7 +/- 2.4 in the control ovary and in the previously operated ovary, respectively (p = 0.01). This drop corresponded to a mean reduction of 42% (95% confidence interval: 10-74%). Basal volumes of the intact and the operated gonads were 5.7 +/- 3.3 and 3.4 +/- 2.3 cm3 respectively (p = 0.01), corresponding to a mean reduction of 39% (95% confidence interval: 12-66%). Laparoscopic excision of nonendometrioid benign ovarian cysts is associated with a significant injury to ovarian reserve.

Laparoscopic excision of urachal cyst found at preoperative examination for ovarian dermoid cyst

A 30-year-old, gravida 1 para 1 married woman was referred to our hospital because of an ovarian dermoid cyst found during a regular check-up. Transabdominal ultrasonography and abdominal magnetic resonance imaging showed the presence of a cystic tumor in the preperitoneal space of the abdominal wall below the umbilicus, in addition to an ovarian dermoid cyst in the pelvic cavity. Under a diagnosis of urachal cyst, laparoscopic excision was performed using LigaSure Atlas at the same time as ovarian cystectomy.

Anesthetic Management during Laparoscopic Excision of an Urachal Cyst in a Pediatric Patient - A case report -

A 14-month-old female patient was admitted for the laparoscopic excision of a complicated urachal cyst. General anesthesia was induced with thiopental and rocuronium and maintained with sevoflurane and the intermittent administration of vecuronium. During the insufflation of her intra-abdominal pressure was maintained below 12 cm to avoid excessive hypercarbia. Thirty minutes after insufflation initiation, end tidal increased to 74 mmHg at a peak inspiratory airway pressure of 24 cm. Laparoscopic excision of the urachal cyst was performed within 2 hours without a further change in end tidal , blood pressure, heart rate, or saturation. Before extubation, saturation by pulse oxymetry was 99% and end tidal was 45-50 mmHg. The patient was discharged without any problem 5 days after the operation. We report on this clinical experience and include a brief review of the literature.

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.

Total cyst excision with ultrasonic scalpel under the laparoscope for choledochal cyst

To discuss the technique and its advantage on application of ultrasonic scalpel in laproscopic cyst excision with Roux-en-Y hepatoenterostomy. Forty-five cases were undergone laparoscopic cyst excision with Roux-en-Y hepatoenterostomy by ultrasonic scalpel. After intraoperative cholangiogram, the gallbladder and the dilated bile duct were completely excised by ultrasonic scalpel. Roux-en-Y hepatoenterostomy was performed extracorporeally through umbilical incision, then an end-to-side anastomosis was carried out intracorporeally. All 45 cases were completely accomplished under laparoscope combined with ultrasonic scalpel. Median duration of operation was 4.2 h (3.5-6.0 h). Intraoperative bleeding was between 10-50 ml (median 15 ml). No complication were found during operation. All children were discharged in 3-9 d (median 5.5 d) after operation. Thirty-eight cases were followed up 1-18 months. No stenosis or ileus occurred. Liver functions were in normal level. Total cyst excision with Roux-en-Y hepatoenterostomy by ultrasonic scalpel under the laparoscope was effective and safe for choledochal cyst. The most excellence was that clearly viewing during operation, less bleeding and injury, free of pain postoperation, microincision and scar.

Initial experience with complex laparoscopic biliary surgery in children: biliary atresia and choledochal cyst

Background Laparoscopic approaches are possible for many pediatric surgical diseases, including complex biliary disorders. The authors describe their early experience with laparoscopic procedures for biliary atresia and choledochal cysts. Methods A retrospective review was performed with Institutional Review Board (IRB) approval of children undergoing laparoscopic Kasai portoenterostomy (n = 2) or laparoscopic excision of a choledochal cyst with Roux-en-y biliary reconstruction (n = 3). The authors report the operative technique for these procedures and present their initial results. Results All procedures were performed with 4 to 5 trocars using 3- and 5-mm ports. Excision of the fibrous biliary remnant (biliary atresia) or of the cyst (choledochal cysts) was performed laparoscopically in all cases. The Roux-en-y limb was created through a 1-cm extension of the umbilical port site. Laparoscopic biliary reconstruction was performed successfully in 4 of 5 patients. In one child, the proximal extent of the choledochal cyst was at the bifurcation of the hepatic duct, and the biliary reconstruction was performed via an open incision with separate anastomoses of the right and left ducts. The gallbladder was used as a handle for retraction of the liver for portal visualization, as in a cholecystectomy, and was resected at the end of the procedure. All children with choledochal cysts have normal bilirubin values. One of 2 children who underwent laparoscopic Kasai has a normal postoperative bilirubin level, whereas the other child did not drain bile and underwent a successful liver transplantation. Mean length of surgery was 338 minutes; mean length of stay was 5.5 days. There were no significant postoperative complications. Cosmesis was excellent in all cases. Conclusions Laparoscopic approaches for children with biliary atresia and choledochal cysts are possible. Excellent visualization of the portal structures can be achieved laparoscopically with adequate retraction of the liver. Further follow-up is needed to determine broader application.

Congenital seminal vesicle cyst and coexisting renal agenesis: laparoscopic approach

We report a case of laparoscopic excision of a large symptomatic left seminal vesicle cyst and ipsilateral renal agenesis. A 26-year-old man presented with a 15-year history of dysuria and irritative voiding symptoms. The diagnostic evaluation revealed a 62 × 40 × 35-mm left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with no evidence of the left renal unit. Transperitoneal laparoscopic excision of the cyst was performed successfully. The total operative time was 190 minutes, and blood loss was minimal. The patient was discharged from the hospital on the second postoperative day and did not present with any complaints or complications thereafter.

Laparoscopic Excision of a Seminal Vesicle Cyst in a Child

Seminal vesicle cyst is an exceedingly rare lesion, manifesting in less than 0.005% of the population.1 Most seminal vesicle cysts are small and asymptomatic. However, when symptoms occur it is usually during the early sexually active period (ie in the second and third decades of life in men).2 Symptoms at presentation may include irritative lower urinary tract problems, abdominal and perineal pain, lower abdominal mass, hemospermia and, rarely, hematuria. The seminal vesicle cyst is often associated with other urological anomalies, including renal agenesis, renal dysplasia and ureteral ectopia.3 Surgical management consists of transrectal aspiration, transurethral unroofing, transurethral resection of the ejaculatory duct, transurethral endoscopic examination and aspiration or open surgical excision. 4–6 The open surgical approach is considered the definitive form of treatment. However, it can be technically challenging and morbid. Recently, the laparoscopic approach has had a significant impact on the management of several urological disorders, including seminal vesicle cysts.7–9 We report the tenth case, and only the second known pediatric case, of a laparoscopic seminal vesicle cyst excision. In this case dissection of the cyst was facilitated by filling the cyst with indigo carmine cystoscopically immediately before laparoscopic excision. CASE REPORT A 7-year-old boy presented elsewhere with a 2-week history of suprapubic pain and dysuria. Initial antibiotic therapy for a presumed urinary tract infection was ineffective. Right testicular swelling subsequently developed and the patient was referred to a urologist. He underwent scrotal exploration, which identified only right epididymitis. Additional antibiotic therapy was given but the symptoms failed to resolve. He was referred to our institution with persistent orchitis. Physical examination revealed an unremarkable abdomen. Scrotal examination demonstrated a mildly enlarged and firm right testicle that was exquisitely tender on palpation. The right epididymis was also enlarged and tender but the spermatic cord was unremarkable. The rest of the examination did not show any other abnormalities. Abdominal, pelvic and scrotal ultrasound revealed an anechoic lesion posterior to the bladder and a mildly enlarged right epididymis along with an absent right kidney. Pelvic magnetic resonance imaging confirmed the absence of the right kidney and the presence of a pelvic cyst located to the right of the midline, consistent with a seminal vesicle cyst (fig. 1). Laparoscopic excision of the seminal vesicle cyst was elected. After induction of general anesthesia cystoscopy was performed with an 11Fr pediatric cystoscope. Examination of the bladder demonstrated elevation of the trigone and bladder base due to the seminal vesicle cyst. The left ureteral orifice was found in an orthotopic position. However, the right ureteral orifice and hemitrigone were absent. The posterior urethra was unremarkable. The ejaculatory duct was cannulated without difficulty using a 75 cm 3Fr ureteral

Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles.

Residual ovarian function after laparoscopic excision of endometriotic ovarian cysts is a major and still unsolved topic. Ultrasonographic evaluation of ovarian response to ovulation stimulation represents a simple yet poorly employed tool to assess residual ovarian function after surgery. Data from patients referred for IVF or ICSI between January 2001 and December 2002 were reviewed. Patients were included who previously underwent laparoscopic excision of a monolateral endometriotic ovarian cyst. The operated ovary and contralateral intact ovary were compared in terms of number of follicles with a mean diameter >15 mm at the time of hCG administration. Basal volume of the two ovaries before initiating stimulation was also compared. A paired Student's t-test was used to investigate differences between the two ovaries. In total, 32 patients and 46 cycles were identified. The mean (+/- SD) number of follicles >15 mm was 4.2 +/- 2.5 in the control ovary and 2.0 +/- 1.5 in the previously operated ovary (P < 0.001); this corresponded to a mean reduction of 53% (95% CI 35-72%) but did not seem to be related to the dimension of the excised ovarian cyst. The basal volume of the operated ovaries was also statistically significantly diminished, though this reduction was less relevant. Excision of endometriotic ovarian cysts is associated with a significant reduction in ovarian reserve. Further studies are required to clarify whether the damage is related to the surgical procedure or to the previous presence of a cyst.

Laparoscopic Excision of a Mesenteric Cyst Diagnosed Preoperatively as an Ovarian Cyst

Mesenteric cysts are uncommon benign, abdominal tumors usually managed by general surgeons. We encountered an unusual mesenteric cyst that was diagnosed preoperatively as an ovarian cyst. It was located in the pelvic cavity inside the mesoappendix. We excised the cyst and adjacent vermiform appendix by laparoscopy. Histopathologic examination revealed mucinous cystadenoma. To the best of our knowledge, this is the first reported case of a mesenteric cyst removed by a gynecologic laparoscopist.

Laparoscopic conservative excision of a rare asymptomatic 11-cm ovarian dermoid cyst containing a mandible with seven teeth

Laparoscopic conservative excision of a rare asymptomatic 11-cm ovarian dermoid cyst containing a mandible with seven teeth

A Case of Esophageal Cyst Excised Successfully Using Laparoscopy

Abstract:Laparoscopic excision of an esophageal cyst was successfully performed on a 29‐year‐old male. The patient, complaining of back pain, was admitted to our hospital for further evaluation of a submucosal esophageal tumor. Close examination revealed a cystic tumor originating from the proper muscular layer at the distal esophagus, measuring 3 cm in diameter. Under general anesthesia, the tumor was excised laparoscopi‐cally without esophageal mucosal injury, with monitering by esophagoscopy. Postoperative esophagography showed no stagnation or stenosis. He was discharged on the 11th postoperative day. The cyst was diagnosed pathologically as an inclusion cyst of the esophagus. Laparoscopic or thoracoscopic surgery is a useful treatment for benign esophageal tumors, because it is less invasive giving more rapid recovery. Concomitant esophagoscopic monitering is beneficial to avoid injury of the esophageal mucosa, especially in such benign tumors that are firmly adherent to the esophageal muscle and mucosal layer.