Renal Cyst Marsupialization Research Articles

Análise retrospectiva dos primeiros 100 casos de cirurgias por retroperitoneoscopia do Centro Hospitalar do Tâmega e Sousa

IntroductionSince the introduction of minimal invasive surgery in the 90s, many international urologic centres have developed retroperitoneoscopy as access way for treatment of multiple urologic pathologies. ObjectivesThe aim of this work is to analyze our initial experience in retroperitoneoscopy. Materials and methods: Retrospective analysis of the first 100 cases of retroperitoneoscopy by counsulting the clinical records. These operations were classified according to their technical difficulty and operative risk. Operative complications were stratified into five grades using the modified Clavien classification system (CCS). ResultsThe first 100 retroperitoneoscopic procedures of our hospital were performed from January 2008 to July 2013 in 51 men and 49 women with a mean age of 52 years old (18‐84 years old).They were comprised of 22 renal cyst marsupialization, 36 Simple Nephrectomies, 4 Radical Nephrectomies, 2 Nephroureterectomies, 14 dismembered pyeloplasties, 1 lumbar ureterolithotomy and 21 Parcial Nephrectomies.Using the classification of surgical complexity European Scoring System for Laparoscopic Operations in Urology modified by Rassweiler in 2006, we classified 22 procedures as simple, 57 procedures as difficult and 21 procedures as very difficult. The mean operation time was 158minutes (range: 67‐280minutes). The mean operation time was 96, 157, and 220minutes in simple, difficult and very difficult procedures, repectively.The open conversion rate was 3%. A total of 12 patients had postoperative complications: CCS Grade I in 4, CCS Grade II in 6 and CCS Grade IIIb in 2 patients. Discussion/Conclusions: The retroperitoneoscopy has proven to be a safe and a versatile access for a minimally invasive treatment of many urologic pathologies.

Laparoendoscopic Single-Site Surgery for Benign Urologic Disease with a Homemade Single Port Device: Design and Tips for Beginners

PurposeA single surgeon skilled in conventional laparoscopic surgery used laparoendoscopic single-site surgery (LESS) to treat benign urological diseases. This study reports our surgical results and introduces a simple technique with tips based on our experience.Materials and MethodsLESS surgery was performed on 116 patients by use of a homemade single-port device composed of an Alexis wound retractor and a powder-free surgical glove. Cases were 44 varicocelectomies (including 8 bilateral cases), 38 renal cyst marsupializations (including 3 bilateral cases), 26 ureterolithotomies (with 1 concomitant ureterolithotomy and contralateral renal cyst marsupialization), 4 prostatic enucleations, and 4 bladder rupture repairs. The mean patient age was 44.43±16.46 years (range, 11 to 76 years), and the male-to-female ratio was 87:29.ResultsIn one ureterolithotomy case, LESS was converted to conventional laparoscopic surgery. The mean operative time was 87.03±45.03 minutes, the estimated blood loss was 61.90 ml (range, 0 to 2,000 ml), and the mean hospital stay was 3.03±2.12 days. Two patients underwent single-port transvesical enucleation of the prostate (STEP) requiring patient-controlled anesthesia. No patients developed major complications, and all patients were satisfied, with 75.86% expressing a high degree of satisfaction.ConclusionsWe report successful treatment outcomes for LESS in 116 cases of benign urological disease. Our findings suggest that LESS can replace conventional laparoscopy.

Laparoendoscopic Single-Site Renal Cyst Marsupialization Using a Homemade Single-Port Device Has a Role as a Feasible Treatment Option

Aim: In patients with a renal cyst and concurrent symptoms, we examined the effectiveness and safety of laparoendoscopic single-site surgery (LESS) for renal cyst marsupialization using a homemade single-port device (HSPD) by a single surgeon (S.W.L.). Patients and Methods: The present study was conducted on a total of 31 patients with a renal cyst. A LESS renal cyst marsupialization was performed using a HSPD based on the Alexis® wound retractor and a powder-free surgical glove. In our study, the mean age was 55.29 ± 10.86 (range 31–73) years and the mean size of the renal cyst was 6.83 ± 1.09 cm. Results: All the surgical procedures were successfully performed. The mean operative time was 101.35 ± 16.04 min. Of the patients who underwent the procedure, none presented with major complications. In 7 patients who had pain preoperatively, there was a significant difference in the visual analogue pain scale score at 6.86 ± 0.69 preoperatively and 1.71 ± 0.49 at postoperative week 4 (p < 0.001). The number of patients who were satisfied with the postoperative outcome was 29 (93.5%). Conclusions: In patients with a simple renal cyst, LESS renal cyst marsupialization using a HSPD might be considered as a feasible, safe surgical treatment option.

Concomitant Laparoendoscopic Single-Site Surgery for Ureterolithotomy and Contralateral Renal Cyst Marsupialization

A 63-year-old woman presented with acute right-flank pain and left-flank pain. Computed tomography identified a right ureter stone and a left renal cyst. The patient underwent concomitant laparoendoscopic single-site surgery (LESS) for ureterolithotomy and renal cyst marsupialization with the use of an Alexis® wound retractor, which was inserted through the umbilical incision. Flexible laparoscopic instruments and conventional rigid instruments were used during LESS following a procedure similar to that used with conventional laparoscopic surgery without additional transcutaneous ports. LESS may be more efficient at treating bilateral diseases than is conventional laparoscopic surgery.

Laparoendoscopic Single-Site Urological Surgery Using a Homemade Single Port Device: The First 70 Cases Performed at a Single Center by One Surgeon

Laparoendoscopic single-site (LESS) surgery was used to treat various urological operations by a single surgeon who was skilled in conventional laparoscopic surgery. The effectiveness and safety of the procedure were examined. LESS surgery was performed on 70 patients by using a homemade single port device composed of an Alexis® wound retractor and a powder-free surgical glove. There were 29 cases of varicocelectomy (including two bilateral cases), 21 cases of renal cyst marsupialization (including one bilateral case), 16 cases of ureterolithotomy, 3 cases of radical nephrectomy, and 1 case of radical nephroureterectomy. The mean patient age was 42.90 ± 17.58 years (range, 11 to 74 years), and the male-to-female ratio was 55:15. In two cases (one ureterolithotomy and one radical nephrectomy), the LESS surgery was converted to conventional laparoscopic surgery. The mean operative time was 96.02 minutes (range, 30 to 285 minutes), the estimated blood loss was 60.80 mL (range, 0 to 500 mL), and the mean hospital stay was 5.10 days (range, 3 to 15 days). Only one patient had to use patient-controlled anesthesia due to pain; none of the patients developed major complications; and all patients were satisfied, with 85.7% expressing a high degree of satisfaction. In the urological field, LESS surgery using a homemade single-port device appears to be a feasible and safe surgical treatment option that could replace conventional laparoscopic surgery.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst

Hoon Ah Jang, Jeong Hyun Ban, Myeong Heon Jin, Mi Mi Oh, Du Geon Moon, Duck Ki Yoon From the Department of Urology, Korea University College of Medicine, Seoul, Korea Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography (CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done. (Korean J Urol 2008;49:454-456) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Comparison of the Surgical Outcome of Laparoscopic Cyst Marsupialization for Peripheral and Parapelvic Renal Cysts

Purpose: The location of renal cysts is related with the symptoms and signs. Parapelvic cysts are a rare form of simple renal cysts, and they are much more commonly associated with the symptoms of obstruction, pain, infection and stone formation. We evaluated the surgical outcomes of laparoscopic renal cyst marsupialization for treating the peripheral and parapelvic types of renal cysts. Materials and Methods: Between November 1993 and April 2007, 87 patients (91 cases) who presented with symptomatic renal cysts underwent laparoscopic renal cyst marsupialization. There were 76 cases in the peripheral cyst group and 15 cases in the parapelvic cyst group. The mean age was 59.2 years (age range: 20-77) for the patients with peripheral renal cysts and 62.9 years (age range: 47-79) for the patients with parapelvic cysts. Results: The mean operative time was 108 minutes (30-280) for the patients with peripheral renal cysts and 144 minutes (80-270) for the patients with parapelvic cysts, and there was a significant difference (p=0.031). However for the other factors, including the time for the first oral intake, the time to remove the drain and the length of the hospital stay, there were no significant differences (p=0.671, 0.088, 0.268, respectively). Complications, including bleeding and leakage, were detected in 11 patients (14.4%) of the peripheral cyst group and in 4 patients (26.6%) of the parapelvic cyst group; there was a statistical difference (p=0.035). Both groups had a high success rate, 98.7% in the peripheral cyst group and 100% in the parapelvic cyst group.

Efficacy of Laparoscopic Renal Cyst Marsupialization for Patients Suffering with Simple Renal Cyst

Purpose: We wanted to evaluate the efficacy of transperitoneal laparoscopic renal cyst decortication for treating patients with symptomatic renal cysts. Materials and Methods: From January 2000 to July 2006, 57 patients with symptomatic renal cysts underwent transperitoneal laparoscopic renal cyst decortication. The mean age of the patients was 56.0 years old (29-77) and the male to female ratio was 1:1.2. The mean size of the renal cysts was 6.6cm (range: 4-11). The laterality of the renal cyst was on the left side in 31 cases, the right side in 11 and it was bilateral in 15. The location of the cysts was at the upper pole in 23 cases, at the middle pole in 13 cases and at the lower pole in 21 cases. All the procedures were performed via the transperitoneal approach. The preoperative and postoperative data were collected retrospectively. The mean follow-up period was 44.1 months (range: 3.2-66.2). Results: The mean operation time was 68.3 minutes (range: 35-280) and the mean blood loss was 42.1cc (range: 30-150). With the mean follow-up of 44.1 months, 52 patients were asymptomatic and 5 patients were still symptomatic. For follow-up, abdominal ultrasonography was performed for 53 of 57 cases and computed tomography (CT) was performed in the others. The success rate was 94.7% (54/57) and the complication rate was 7.0% (4/57). Conclusions: Laparoscopic renal cyst decortication in patients with symptomatic renal cysts via the transperitoneal approach seems to be an effective procedure to achieve symptomatic relief with minimal morbidity and an acceptable long-term success rate. (Korean J Urol 2007;48:477-482)

Why Is Urological Laparoscopy Minimally Invasive?

Objectives: Laparoscopic procedures have been developed and established with the view that a similar operative effect can be achieved with less traumatization, especially as far as systemic stress response is concerned. We report a prospective, controlled, nonrandomized animal and patient study to determine the systemic response to laparoscopic and open surgical procedures. Methods: In the animal study, 26 female pigs underwent either a laparoscopic bilateral varix ligation followed by bilateral nephrectomy (group I), sole introduction of trocars (group II) or sole establishment of an open surgical approach (group III). In the patient study, 145 patients underwent various laparoscopic procedures (nephrectomy, renal cyst marsupialization, varix ligation), open surgical procedures (nephrectomy, inguinal orchiectomy) or extracorporeal shockwave lithotripsy (ESWL). The serum parameters interleukin (IL)–6, IL–10 and C–reactive protein (CRP) were measured before, during and after the operative procedure. Results: In animals and patients, laparoscopy resulted in significantly lower serum levels of CRP during and after the operative procedure. Animals in group I showed a 5–fold elevation, in group II a 3–fold elevation and in group III a 9–fold elevation of CRP. In patients, the increase of CRP was twice as high after open unilateral nephrectomy than after laparoscopic unilateral or bilateral nephrectomy. IL–6 showed less marked elevation during laparoscopy, ESWL and minor operative procedures like laparoscopic varix ligation or inguinal orchiectomy when compared to an open unilateral nephrectomy. The parameter IL–10 showed no significant differences among the patient groups. Conclusions: The extent of the acute phase reaction to the operative trauma correlates much more convincingly to the approach than to the extent of the procedure. Only larger operations like nephrectomy trigger a systemic acute phase reaction, which can be limited by the laparoscopic access. For minor operative procedures like varix ligation or exploration of cryptorchidism, laparoscopy offers technical advantages rather than minimal invasiveness.

Needlescopic urology: incorporating 2-mm instruments in laparoscopic surgery

Objectives. To report the initial experience with incorporation of needlescopic (2 mm) instruments and optics in various therapeutic minimally invasive urologic procedures. Methods. Needlescopic techniques were used to successfully perform a variety of urologic surgeries including adrenalectomy, nephrectomy, renal cyst marsupialization, orchiopexy, lymphocele marsupialization, and pelvic lymph node dissection. Results. To date we have performed 42 needlescopic procedures in 39 patients (14 female and 25 male) ranging in age from 8 months to 87 years (mean 46.6 years). Three procedures were converted to conventional laparoscopy and one to open surgery, yielding a needlescopic success rate of 90.5%. Surgical times averaged 132 minutes and blood loss averaged 67 mL. Procedures were performed on an outpatient basis in 33.3% of cases, and 94.9% of patients were discharged home within 23 hours. The overall complication and conversion rate was 14.3% and there was no mortality. Conclusions. Our initial experience is quite promising. In select patients, needlescopic urologic surgery is feasible and safe, and may reduce postoperative pain, hospital stay, and recovery time, and improve cosmesis. Further evaluation of, and improvement in, 2-mm instrumentation and optical technology is needed.

Laparoscopic Marsupialization of the Painful Polycystic Kidney

Autosomal dominant polycystic kidney disease patients may present with intractable cyst pain. Common practice has been to attempt percutaneous drainage of the affected cyst and, if unsuccessful, to offer open surgical decortication. We report laparoscopic renal cyst marsupialization for painful autosomal dominant polycystic kidney disease among 6 patients who failed prior percutaneous drainage. Mean surgical and anesthesia times were 3 hours and 3 hours 35 minutes, respectively. Mean blood loss was 140 cc. Median intervals to ambulation, oral intake and hospital discharge were 1.5, 1.5 and 3 days, respectively. All 6 patients reported pain relief with followup of 6 to 40 months. These results suggest that laparoscopic marsupialization of painful autosomal dominant polycystic kidney disease is technically feasible and safe, and the laparoscopic approach may offer a palliative option for patients in whom prior percutaneous management failed.

Retroperitoneal Laparoscopic Nephrectomy and Other Procedures in the Upper Retroperitoneum Using a Balloon Dissection Technique

This article describes a hydraulic balloon dissection technique. The retroperitoneum is developed via a small lumbodorsal incision between the edges of the musculus latissimus dorsi and musculus obliquus externus and then after visualization of its correct position the balloon catheter is filled with 500-1,200 ml of warm normal saline (according to patient size). The device consists of the finger of a surgeon's glove ligated around the end of a rigid bladder catheter. The balloon insufflation is maintained for 5 min to guarantee adequate hemostasis. Recently, we have replaced the balloon catheter by a balloon trocar sheath allowing direct endoscopic control of the hydraulic dissection. After retrieval of the balloon the CO2 insufflator is connected to the first trocar. All secondary trocars are placed under endoscopic control. The hydraulic dissection techniques also enable optimal creation of an effective pneumoperitoneum in children. Until now, we have used this technique for twelve procedures in the upper retroperitoneum including five nephrectomies, two nephroureterectomies, one tumor nephrectomy, one nephropexy, one renal cyst marsupialization and two renal biopsies. Up to now we have encountered no major complications. Three of the nephrectomized patients had undergone multiple previous abdominal surgical interventions. The retroperitoneal approach allows the surgeon to apply similar dissecting techniques as used in respective open procedures. It has become the routine approach for laparoscopic procedures in benign renal disease. This procedure can be performed even in cases with previous abdominal surgery.