Urology - Oncology, Laparoscopy, General Urology Mischel Neill - BHB MBCHB FRACS - Urology - Oncology, Laparoscopy, General Urology Urology - Oncology, Laparoscopy, General Urology

Deroofing Renal Cyst

A cyst is a benign (non-cancerous) collection of fluid. Kidney cysts are very common (a third of us have one) and usually cause no problems. Occasionally, as cysts increase in size they may push on the kidney or the ureter (drainage funnel of the kidney) which may lead to pain or hypertension (high blood pressure). When cysts are not causing any symptoms, intervention is not indicated, however if they become symptomatic then drainage is recommended. Usually this can be done with a fine needle through the skin under local anaesthetic with ultrasound guidance, however recurrence might best be managed with surgical drainage and removal of the cyst wall.

Laparoscopy is commonly known as "keyhole surgery”, however although the incisions are small the view is not. Modern equipment produces a wide, bright, clear and magnified view of the operation, often superior to the traditional open approach. In addition, the gas used to distend the abdomen during laparoscopy also greatly reduces bleeding during surgery.

Traditionally the surgical approach to the kidneys requires a 20-25cm incision because the kidneys lie high in the abdomen, beneath the ribs. The laparoscopic operation is performed through 3 x 5-10 mm cuts below the ribs on the side of the abdomen. The kidney is identified and the cyst is exposed. It is then "deroofed” (i.e. the roof or outer aspect of the cyst wall is removed) and the fluid drained. For deroofing of a renal cyst it may be necessary to inject dye into the ureter during the operation to see if a connection exists between the cyst and ureter. To do this cystoscopy (inspection of the bladder with an optical scope) is required for the insertion of a fine catheter into the lower end of the ureter. The remaining inner cyst wall is treated to help reduce the chance of any future recurrences. Rarely technical difficulties may make the operation unable to be completed laparoscopically, if this eventuates conversion to the open procedure may be achieved without difficulty. The likelihood of this happening is less than 2%.

Thousands of cases of laparoscopic kidney surgery have been performed around the world since 1991. The medical literature suggests that it is just as effective as open surgery for both cancerous and non-cancerous reasons but avoids the painful incision that results in a longer hospital stay and recovery time.

After the operation

Laparoscopy does not eliminate post-operative pain however any discomfort experienced should be easily controlled using the pain-killers you will be prescribed. The expected hospital time is between 2-4 days (compared with 5-8 days following open surgery). The stitches used to close the wounds are buried and will dissolve.

Although the incisions are small, a significant operation has taken place internally and as such you should not undertake strenuous physical exercise, even if you feel like it, until at least 3 weeks (A return to full activities may take 6-12 weeks with an open approach). You may drive as soon as you think you could brake hard and swerve quickly to avoid an accident (typically 2 weeks). Follow-up will be different for different people but should be clear before discharge.

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© Mr Mischel Neill BHB MBCHB FRACS Urology Oncology, Laparoscopy, General Urology Auckland New Zealand Your Practice Online
Urology - Oncology, Laparoscopy, General Urology Mischel Neill - BHB MBCHB FRACS Royal Australasian College of Surgeons Urological Society of Australia and New Zealand