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Minimally Invasive Surgery / Laparoscopic Procedures
Unroofing of Renal Cysts and Renal Biopsy
- Indications - Cysts can form in the kidney for many reasons and mostly are non-cancerous, benign and require no further intervention. However, in some instances a cyst may enlarge to the point that it causes pain, obstructs the kidney or leads to high blood pressure. Cysts may become infected or bleed. Sometimes a cyst, which at one time appeared benign, may change its shape or features to the extent that malignancy is suspected. For any of the above reasons cyst unroofing and subsequent biopsy may be required. In addition certain renal diseases require a biopsy for diagnosis.
Laparoscopy has provided an ideal way to manage these problems. No large incisions are required, direct visualization of the cyst and/or kidney is provided and tissue for the pathologist is obtained for more detailed evaluation. In addition an ultrasound probe may be placed through one of the ports to examine the remainder of the kidney with the highest resolution possible.
- Procedure - The patient must undergo general anesthesia for this procedure. Two to three small cylindrical tubes called trocars are placed into the abdominal cavity. The trocars allow entry of a video-telescope, called a laparoscope, to view the entire abdominal cavity and kidney. Accessory small trocars allow the introduction of fine instruments necessary to perform surgery. With all the trocars and instruments in place the surface of the cyst is completely exposed and cyst fluid is drained. The cyst is then cut out and the base of the cyst biopsied. The cyst fluid and biopsy are sent to the pathologist for analysis. When only a kidney biopsy is required a portion of the kidney is exposed and a biopsy is taken. An advantage of this technique is that an ultrasound probe may be placed through the trocar directly onto the kidney to help guide where the biopsy should be performed and to image the kidney.
- Result -Investigators have demonstrated success rates in greater than 95% in patients undergoing cyst unroofing with low complication rates. Operative time averages 90 minutes. Hospital stay is less then 48 hours in most cases. Pain medication requirement is minimal and return to work is often within 2 to 3 weeks. Other options to treat this problem include an open incision. In cases requiring an open procedure pain medication, hospital stay and time to return to work are all longer. Another method to treat renal cysts and/or renal biopsy is placing a needle through the skin into the cyst and/or kidney using the help of x-rays. In theory this procedure is less invasive than laparoscopy however this technique does not allow direct visualization of the kidney or cyst, does not provide a large sampling of tissue, does not allow for high resolution ultrasound guidance and has a relatively high incidence of recurrence when performed for cyst management.
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