Laparoscopic ablation/decortication in the treatment of symptomatic large benign renal cysts: outcomes survey results.

In an attempt to determine which patients will benefit from laparoscopic surgical treatment, we evaluated cyst characteristics, pre-op symptoms, and post-op pain improvement, using the Wong-Baker analog pain scale. We reviewed 27 consecutive patients with symptomatic large benign rental cysts who were treated with laparoscopic cyst decortication and ablation of the cyst base using argon beam coagulation between October 1994 and August 2003. Wong-Baker pain scale was used to assess pre and post-op pain. We analyzed (1) symptom resolution with surgery, (2) size of cyst, (3) surgical technique, and (4) cyst fluid cellularity and histopathology. Twenty-two (81%) were treated because of flank and abdominal pain. Follow-up was 2 to 80 months (avg: 20 months). Fifteen patients (56%) underwent argon beam coagulation of the cyst base and 14 (54%) had perinephric fat interposition laparoscopically sutured into the cyst cavity, and all 27 were done using the transabdominal approach. Mean cyst size was 8.9 cm (range: 6-17). Of the 22 patients who underwent the procedure for pain, 19 (86%) were symptom free after surgery, 2 (9.5%) reported some improvement of symptoms, and 1 (5%) needed a second laparoscopic procedure for recurrence. One patient (5%) underwent open conversion because of intraoperative bleeding. No cysts recurred. Mean op time was 76 minutes (range: 48-128). Laparoscopic renal cyst ablation/decortication is an effective and minimally invasive treatment for symptomatic renal cysts.

M. Walls, F. Mendez, R. Urena, and R. Thomas. Tulane University School of Medicine, Department of Urology, New Orleans, LA.