ENDOUROLOGY & LAPAROSCOPY

Long-term Durability of Laparoscopic Decortication of Symptomatic Renal Cysts
Atug F, Burgess SV, Ruiz-Deya G, Mendes-Torres F, Castle EP, Thomas R
Department of Urology, Center for Minimally Invasive Urologic Surgery, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
Urology. 2006; 68: 272-5

• Objectives: To assess the long-term results of patient symptoms and radiologic outcomes of laparoscopic renal cyst decortication in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population. Symptomatic renal cysts have traditionally been treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence.
• Methods: From April 1994 through July 2005, 45 patients underwent laparoscopic decortication of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. Of the 45 patients, 24 (53.3%) had undergone previous cyst aspiration with injection of sclerosant material for intended ablation. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan.
• Results: Of the 45 procedures, 44 were completed laparoscopically. One patient (1.8%) underwent open conversion because of excessive bleeding. The mean operative time was 89 minutes (range 48 to 170). Symptomatic success was achieved in 91.1% of patients, with a median follow-up of 52 months (range 3 to 132), and radiographic success was achieved in 95.5% of patients, with a median follow-up of 39 months (range 3 to 96).
• Conclusions: Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.
  
  
• Editorial Comment
  The treatment of symptomatic renal cysts has evolved with the advent of laparoscopic surgery. The authors demonstrated that the minimally invasive surgical technique may offer a durable success rates with minimal morbidity. Although the Percutaneous approach of cyst aspiration may offer a different less invasive alternative, it is well known that the recurrence rates are higher, independent of the use of sclerosing agents or not. The Laparoscopic surgery combines the advantages of a minimally invasive procedure with the effectiveness of cyst marsupialization achieved by open surgery, as well as, the capability of ablating the epithelial surface of the cyst with argon beam coagulators or even with monopolar cautery due to the better visualization secondary to the magnification achieved by the laparoscope.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA