Renal Cyst Unroofing
Renal cysts are often detected on renal ultrasound and/or computed tomography (CT). These cysts are categorized based on the Bosniak Classification system. A Bosniak I or II are usually benign, and a Bosniak III or IV have a higher chance of being cancerous. Prior to proceeding with surgery, the patient and his/her surgeon make a decision to operate on the renal cysts. Usually for renal cysts with a higher Bosniak classification, a partial nephrectomy (LINK) or radical nephrectomy (LINK) is performed. For renal cysts with a lower Bosniak classification (I or II), renal cyst decortication can be performed to either assess whether it has a cancerous component and/or to relieve pain caused by the cyst(s). At the University Of Chicago Hospitals we offer the laparoscopic approach to renal cyst decortication. The patient is first placed to sleep. Then he/she is turned onto the side (FIG). 4-5 key-hole size incisions are placed on the same side of the body as the kidney. The surgeon’s hands are not inside the patient’s body during surgery. A video camera and long instruments are inserted through these key-hole incisions. The surgeon watches a television monitor which gives him a view of inside of the abdomen. The cyst and part of the kidney are exposed. A long needle is then used to puncture the cyst and suck the fluid from the cyst. If the fluid appears clear without evidence of blood, the cyst wall is opened and removed. The base of the cyst defect is inspected to assure there is no evidence of renal tumors. Once this is assured, the defect is coagulated. The surgery is completed at this point, after seeing that there is no bleeding present.
The laparoscopic approach has numerous advantages over the conventional open approach. First, the patient will feel less pain postoperatively compared to the open approach. This is in part due to the small keyhole incisions made as compared to an open renal cyst decortication, which could result in a 6-7” incisional scar. Another reason for less pain is less trauma since large metal retractors for keeping the incision open are not needed. Less pain also means faster recovery. The patients are typically given regular diet and are walking about by the first day after surgery. The patients usually stay in the hospital for 2 days, and the patients are back to their normal activities by approximately 4 weeks following surgery. In addition to these advantages, the laparoscopic approach also offers a better cosmetic result due to the small and almost negligible incisional scars over time.