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Khoder WY, Grabbert M, Sigle A, Astheimer S, Vallo S, Gratzke C. Retrospective Evaluation of the Clinical Values of Minimally Invasive Marsupialization of Symptomatic Giant Renal Cysts. J Laparoendosc Adv Surg Tech A 2020; 31:279-283. [PMID: 33074753 DOI: 10.1089/lap.2020.0415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: To evaluate the indication and benefit of minimally invasive laparoscopic marsupialization (MIS) of symptomatic giant renal cysts. Materials and Methods: Sixty-four consecutive patients who underwent MIS for large renal cysts (Bosniak I; 4 × 5-16 × 12 cm) by one surgeon were included in the study. Presenting symptoms were renal pain (100%), associated with hypertension (28%), renal dysfunction (4.7%), hematuria (4.7%), ureteropelvic junction obstruction (UPJO) (7.8%), ipsilateral urolithiasis (4.7%), polycystic kidney (6.3%), adrenal cyst (1.6%), and retroperitoneal cysts (1.6%). Seven patients with peripelvic cysts and previous retroperitoneal operations were treated by a laparoscopic approach; all other patients underwent retroperitoneoscopic marsupialization. Single-port retroperitoneoscopy was performed in 4 patients. Follow-up included clinical examination, abdominal ultrasound, and computed tomography scan. Postoperative radiologic success was defined as a minimum of 50% in size reduction and no recurrence. Results: Mean patients' age was 46 (21-65) years. All procedures were successfully completed without conversion or revision. Mean operative time was 55 (40-85) minutes with a mean hospital stay of 3 days. All patients underwent uneventful postoperative recovery. Observed minor complications (transitory fever/pain) were found in 4 patients during the first postoperative month. Median follow-up was 12 months (10 months-2 years). About 98.5% of patients reported of no relevant postoperative pain. A relief from UPJO and hematuria was achieved in 100% of patients. Ten patients with known hypertensive disease (55.6%) had a significant reduction of mean blood pressure resulting in a reduction of antihypertensive medication. Ureterorenoscopic stone extractions were performed successfully afterward. No cyst recurrences were detected during the follow-up period. Conclusion: Treatment indications for symptomatic renal cysts could include not only symptoms but also associated diseases like UPJO and hypertension. Retroperitoneoscopic MIS may be curative for these cyst-associated pathologies. The feasibility, safety and efficacy of these techniques could be demonstrated.
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Affiliation(s)
- Wael Y Khoder
- Department of Urology, Freiburg University Hospital, Freiburg, Germany
| | - Markus Grabbert
- Department of Urology, Freiburg University Hospital, Freiburg, Germany
| | - August Sigle
- Department of Urology, Freiburg University Hospital, Freiburg, Germany
| | - Sophie Astheimer
- Department of Urology, Freiburg University Hospital, Freiburg, Germany
| | - Stefan Vallo
- Klinik für Urologie, Hochtaunus-Kliniken, Bad Homburg vor der Höhe, Germany
| | - Christian Gratzke
- Department of Urology, Freiburg University Hospital, Freiburg, Germany
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Erdem MR, Tepeler A, Gunes M, Sılay MS, Akman T, Akcay M, Armagan A, Onol SY. Laparoscopic decortication of hilar renal cysts using LigaSure. JSLS 2014; 18:301-7. [PMID: 24960497 PMCID: PMC4035644 DOI: 10.4293/108680813x13753907291558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: In this study, we evaluated the safety and efficacy of using the LigaSure sealing system (Valleylab, Boulder, Colorado) for laparoscopic decortication of symptomatic hilar renal cysts. Methods: Seventeen patients underwent laparoscopic decortication of hilar renal cysts with the LigaSure system. Our study included only symptomatic, Bosniak type 1, simple and symptomatic renal cysts. The operative route, transperitoneal or retroperitoneal, was planned according to the location confirmed by computed tomography. The patients' symptoms were preoperatively and postoperatively evaluated by the Wong-Baker visual pain scale. Operative measures and radiologic outcomes were prospectively evaluated. Results: The mean age of the patients was 56.4 years, and the mean follow-up period was 12.5 months. Preoperative computed tomography showed only a single cyst in 15 patients (88.2%) and showed two separate cysts in 2 cases (11.8%). The cysts were located in the perihilar region close to the vascular structure in all patients. A transperitoneal approach was used in 9 patients, and a retroperitoneal approach was used in 8 patients. The mean operative time and hospitalization time were 56.4 minutes and 1.2 days, respectively. Minor complications were observed in 3 patients. Symptomatic and radiologic success rates of 94.2% and 100%, respectively, were achieved. Conclusion: Laparoscopic decortication of symptomatic hilar renal cysts—first reported in the literature in this study—using the LigaSure sealing system is feasible, effective, and safe, even if the cyst is located in the perihilar area.
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Affiliation(s)
- Mehmet Remzi Erdem
- Urology Department, Haydarpasa Research and Training Hospital, Tibbiye Street, Selimiye, Uskudar, Istanbul, Turkey.
| | | | - Mustafa Gunes
- Urology Department, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Tolga Akman
- Urology Department, Bezmialem Vakif University, Istanbul, Turkey
| | - Muzaffer Akcay
- Urology Department, Bezmialem Vakif University, Istanbul, Turkey
| | - Abdullah Armagan
- Urology Department, Bezmialem Vakif University, Istanbul, Turkey
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Yang D, Xue B, Zang Y, Liu X, Zhu J, Chen D, Tao W, Shan Y. A modified laparoendoscopic single-site renal cyst decortication: single-channel retroperitoneal laparoscopic decortication of simple renal cyst. J Laparoendosc Adv Surg Tech A 2013; 23:506-10. [PMID: 23597186 DOI: 10.1089/lap.2012.0411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laparoscopic renal cyst decortication often uses three-port incisions or single-port incision with three or four channels (laparoendoscopic single-site surgery). This article introduces a modified laparoendoscopic single-site surgery for the treatment of simple renal cysts: single-channel retroperitoneal laparoscopic decortication (SCRL) of a simple renal cyst. PATIENTS AND METHODS From January 2008 to December 2011, either SCRL or standard three-port-incision retroperitoneal laparoscopic decortication (SRL) was performed for the treatment of a simple renal cyst. The SCRL procedure was as follows. The patients were placed in the lateral decubitus position. A 1.2-cm horizontal skin incision was made over the midaxillary line, 3 cm above the iliac crest. The retroperitoneum working space was established. A 10-mm operative laparoscope, which is similar to a nephroscope, was introduced into the retroperitoneum cavity through a 1.1-cm port. The cyst was exposed and then sutured to help to suspend the cyst wall so that the cyst could be decorticated easily. Perioperative and follow-up data from SCRL and SRL were collected retrospectively. RESULTS Based on the cyst location as the major selection criterion, 92 cases were enrolled for further analysis. Of these, 38 patients were treated with SCRL, and 54 patients were subjected to SRL. No SCRL was converted to SRL, and no SRL was converted to open surgery. The operation time and the drain tube removal time in these two approaches were similar (P>.05), but the average duration of hospital stay in the SCRL group was shorter (P=.02). Six months after the surgery, renal ultrasound results showed that the diameter of the cyst in these two groups also had no significant difference (P>.05). CONCLUSIONS With appropriate selection of patients, the SCRL approach has the same efficacy with better cosmesis compared with SRL.
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Affiliation(s)
- Dongrong Yang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Retroperitoneoscopic Decortication of Symptomatic Peripelvic Renal Cysts: Chinese Experience. Urology 2011; 78:803-7. [DOI: 10.1016/j.urology.2011.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Revised: 06/10/2011] [Accepted: 06/10/2011] [Indexed: 11/19/2022]
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Tuncel A, Aydin O, Balci M, Aslan Y, Atan A. Laparoscopic decortication of symptomatic simple renal cyst using conventional monopolar device. Kaohsiung J Med Sci 2011; 27:64-7. [PMID: 21354520 DOI: 10.1016/j.kjms.2010.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/03/2010] [Indexed: 11/30/2022] Open
Abstract
In our study, we assessed the efficacy, safety, and feasibility of laparoscopic decortication of symptomatic simple renal cysts using conventional monopolar device. Long-term symptomatic and radiological results of 15 patients who underwent laparoscopic renal symptomatic simple cyst decortication, which was performed by conventional monopolar device, were retrospectively reviewed. The mean age of the patients was 49.7 years. There were nine male and six female patients. Their presenting symptoms were lumber pain in 93% (n=14), and hypertension in 7% (n=1). The mean operating time was 64.6 minutes. The mean hospital stay was 2.2 days. After a mean follow up of 12.08 months, the radiological and symptomatic successes were 100% and 86.6%, respectively. Laparoscopic renal cyst decortication using conventional monopolar device represents an effective and safe treatment option in the management of renal cyst without any need for more expensive energy sources.
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Affiliation(s)
- Altug Tuncel
- Ministry of Health, Ankara Numune Research and Training Hospital, Third Department of Urology, Ankara, Turkey.
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Emre H, Turgay A, Ali A, Murat B, Ozgür Y, Cankon G. 'Stepped procedure' in laparoscopic cyst decortication during the learning period of laparoscopic surgery: Detailed evaluation of initial experiences. J Minim Access Surg 2010; 6:37-41. [PMID: 20814509 PMCID: PMC2924546 DOI: 10.4103/0972-9941.65162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We evaluated the importance and efficacy of 'stepped procedure' in laparoscopic cyst decortication as an initial experience in it. MATERIALS AND METHODS A 36 renal cyst cases were included. The stepped retroperitonoscopic cyst excision divided into three groups. First step, doing the incisions to place the ports and expanding the retroperitoneal space with balloon distension, second step, placement of trocars and reach to the cyst, third step, aspiration and decortication of the cyst. The difficulty of the sessions was measured with the Visual Analog Scale (VAS) scoring system. Score was determined according to the difficulty of the surgical step ranging from '0' to '10', '0', too easy, '10' too difficult'. The durations were measured. One-way ANOVA test was used for statistical analysis. RESULTS The mean age was 52.0 (20-75) years. The mean operation time was 52.0 min. The mean duration of the first step was 12.5, second, 26.0 and third, 22.5 min. The mean VAS of first step, 3.2, second, 6.0 and third, 3.6 There were only significant differences in duration time and VAS score for second step among the surgeons (P<0.05). CONCLUSIONS Laparoscopic cyst decortication may provide gaining experience to approach the kidney laparoscopically. The side, size and localization of cysts were not found associated with the difficulty of the method.
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Affiliation(s)
- Huri Emre
- Department of Second Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey
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Ryu DS, Oh TH. Laparoscopic Decortication of Large Renal Cysts: A Comparison Between the Transperitoneal and Retroperitoneal Approaches. J Laparoendosc Adv Surg Tech A 2009; 19:629-32. [DOI: 10.1089/lap.2009.0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dong-Soo Ryu
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Tae-Hee Oh
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Hajj P, Ferlicot S, Massoud W, Awad A, Hammoudi Y, Charpentier B, Durrbach A, Droupy S, Benoît G. Prevalence of renal cell carcinoma in patients with autosomal dominant polycystic kidney disease and chronic renal failure. Urology 2009; 74:631-4. [PMID: 19616833 DOI: 10.1016/j.urology.2009.02.078] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Revised: 02/12/2009] [Accepted: 02/22/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To study the prevalence and the characteristics of renal cell carcinoma (RCC) in patients with autosomal dominant polycystic kidney disease (ADPKD) in our series. METHODS We reviewed retrospectively all the nephrectomies performed in our department between 1982 and 2003 in patients with ADPKD and chronic renal failure. RESULTS Seventy-nine patients (42 males and 37 females) with ADPKD and chronic renal failure underwent 89 nephrectomies; in 10 of 79, both kidneys were removed but not simultaneously. Mean age was 50.4 years (range, 32-69 years). Of 79 patients, 50 had end-stage renal disease (ESRD) and were on hemodialysis or had received a transplant for >1 year. On histologic examination, 11 of 89 kidneys were diagnosed with carcinomas. There was 1 patient with bilateral tumor (tubulopapillary Ca) and 3 kidneys (27.3%) with multifocal tumors. Regarding the histologic type, there were 7 of 12 (58.3%) clear cell carcinomas and the remaining 5 (41.7%) were tubulopapillary carcinomas. CONCLUSIONS The prevalence of RCC was higher in patients with ADPKD and ESRD, with >1 year on dialysis or renal transplantation undergoing nephrectomy according the protocol. It would be 2 to 3 times more frequent than RCC in patients with ESRD alone. The clinician should maintain a high alert of suspicion for RCC in such patients.
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Affiliation(s)
- Pascal Hajj
- Department of Urology, Bicetre University Hospital, Université Paris sud, Le Kremlin Bicetre, France.
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A New Technique for Simple Renal Cyst: Cystoretroperitoneal Shunt. Adv Urol 2009:906013. [PMID: 19606254 PMCID: PMC2709719 DOI: 10.1155/2009/906013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 05/22/2009] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the results of patient symptoms and radiologic outcomes of cystoretroperitoneal shunt (CRS) technique in the treatment of symptomatic simple renal cysts. Patients and Methods. In a prospective study, 37 patients with a simple renal cyst were treated with ultrasound-guided percutaneous CRS-catheter. Radiological success was indicated as no recurrence of the cyst or a reduction in cyst volume by at least half. Results. CRS technique was performed successfully in 36 patients with a simple renal cyst. The mean size of all cysts decreased from 8.8 cm (range 7 to 14) to 1.7 cm (range 0 to 9; P < .001). Symptomatic success (pain relief) was achieved in 29/36 (80.5%) of patients, and radiographic success was achieved in 23/36 (63.8%) of patients, with a median follow-up of 16 months (range 6 to 24). Conclusion. Ultrasound-guided percutaneous CRS technique for simple renal cysts is fast, safe, effective, and inexpensive.
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Mingoli A, Brachini G, Binda B, Carocci V, Tiddi C, Modini C. Laparoscopic Transperitoneal Decortication of a Giant Peripelvic Renal Cyst. J Laparoendosc Adv Surg Tech A 2008; 18:845-7. [DOI: 10.1089/lap.2008.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Mingoli
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
| | - Gioia Brachini
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
| | - Barbara Binda
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
| | - Valentina Carocci
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
| | - Corinna Tiddi
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
| | - Claudio Modini
- Emergency Department, Division of Trauma and Emergency Surgery, Sapienza University, Rome, Italy
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Abbaszadeh S, Taheri S, Nourbala MH. Laparoscopic decortication of symptomatic renal cysts: Experience from a referral center in Iran. Int J Urol 2008; 15:486-9. [PMID: 18422580 DOI: 10.1111/j.1442-2042.2008.02031.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shahin Abbaszadeh
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Teber D, Tefekli A, Eskicorapci S, Gözem AS, Bujosevic S, Sugiono M, Stock C, Rassweiler JJ. Retroperitoneoscopy: A Versatile Access for Many Urologic Indications. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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