Laparoscopic decortication of large renal cysts: a comparison between the transperitoneal and retroperitoneal approaches.

ABSTRACT

BACKGROUND: We compared the operative outcomes and follow-up results of laparoscopic decortication of large, simple renal cysts, performed by the transperitoneal (TP) and retroperitoneal (RP) approaches, and identified selection criteria for each approach. MATERIALS AND METHODS: Between 2000 and 2007, 53 patients with renal cysts underwent laparoscopic decortication via the TP (n = 25) and RP approaches (n = 28), according to the location of the cysts. Operative and follow-up data were collected retrospectively, and the approaches were compared with regard to intra- and postoperative parameters, complications, and success rate. RESULTS: Among the 53 patients, 48 (90.5%) had their cysts completely removed, and in 5 (9.5%), the cyst size was reduced to less than one half of the initial cyst volume. Thirty-three patients (84.6%) had their symptoms completely relieved within 3 months, while 6 patients (15.3%) had continued mild pain. There were no significant differences in the symptomatic response and radiologic findings between the two approaches. The RP approach had the advantages of reduced operation time, time to oral intake and ambulation, as well as analgesic use. One patient in the RP group required laparoscopy to control postoperative bleeding. CONCLUSIONS: Based on the cyst location, as the major selection criteria, both approaches were comparable with regard to symptomatic improvement and radiologic findings. The retroperitoneal approach had the advantages of reduced operation time, time to oral intake and ambulation, as well as analgesic use. Therefore, we prefer to perform laparoscopic decortication by the retroperitoneal approach without mobilization of the bowel.