Semptomatik Basit Böbrek Kistlerinin Tedavisinde Üç Boyutlu Laparoskopik Kist Dekortikasyonu: Ülkemizden İlk Hasta Serisi
Amaç: Çalışmada, kliniğimizde üç boyutlu laparoskopik yöntemle tedavi edilen semptomatik basit böbrek kisti olan hastaların sonuçları değerlendirildi. Gereç ve Yöntem: Ağustos 2016 ve Ekim 2018 tarihleri arasında semptomatik böbrek kisti nedeniyle üç boyutlu görüntüleme eşliğinde laparoskopik kist dekortikasyonu uyguladığımız 23 hasta değerlendirildi. Hastalar cinsiyet, yaş, semptom, kistin yeri, kistin boyutu, ameliyat süresi, hastanede yatış süresi ve komplikasyonlar yönüyle incelendi. Bulgular: Hastaların ortalama yaşları 57.3 ± 11.8 (27-73) yıl, 7’si (%30.4) kadın, 16’sı (%69.6) erkek idi. En sık semptom ağrıydı. Ortalama kist çapı 8.1 ± 2.5 (53-126mm) cm olarak tespit edildi. Bütün hastalar üç boyutlu görüntüleme eşliğinde 16 hastaya transperitoneal, 7 hastaya ise retroperitoneal yaklaşımla cerrahi uygulandı. Kistlerin 17 tanesi sağ, 6’sı ise sol böbrek yerleşimliydi. Ortalama hastanede yatış süresi 2.2 ± 0.4 (2-3) gün olup, ortalama operasyon süresi 29.8 ± 5.6 (19-42) dakika olarak gerçekleşti. Bütün kistler Bosniak tip1 olarak sınıflandırılmıştı. Bütün kistlerin patolojisinde malignite bildirilmeyip benign olarak rapor edildi. Hiçbir olguda semptomatik ve radyolojik nüks görülmedi. Sonuç: Semptomatik basit böbrek kistlerinin tedavisinde üç boyutlu görüntüleme eşliğinde uygulanan laparoskopik kist dekortikasyonu tedavisi tekrarlama ve morbidite oranı düşük, güvenle tercih edilip uygulanacak bir yöntemdir.
Cyst Decortication with 3D Laparoscopy in the Treatment of Symptomatic Simple Kidney Cysts: First Case Series from Turkey
Objective: In this study we evaluated the results of 3D laparoscopic treatment method by symptomatic simple kidney cysts. Material and Method: A total of 23 patients undergoing 3D laparoscopic cyst decortication due to symptomatic simple kidney cysts between August 2016 and October 2018 were evaluated. Evaluation criteria were sex, age, symptom, localisation and size of the cyst, duration of operation hospital stay and complications. Results: Mean age of the patients was 57.3 ± 11.8 (27-73) years, 7 (30.4 %) of the patients were female and 16 (%69.6) were male. The most common symptom was pain. Mean cyst diameter was 8.1 ± 2.5 (53-126 mm) cm. In assistance of 3D imaging,16 patients received treatment under transperitoneal and 7 patients under retroperitoneal approach. Localisation of the cysts were as 17 at left and 6 at the right side. Mean duration of hospital stay was 2.2 ± 0.4 (2-3) days and mean operation time was 29.8 ± 5.6 (19-42) minutes. Whole cysts were evaluated as Bosniak type1. Histopathologic evaluation revealed simple kidney cysts with no sign of malignancy. No radiological and symptomatic recurrence was observed in any of the cases. Conclusion: Laparoscopic cyst decortication in assistance with 3D imaging in the treatment of symptomatic simple kidney cysts is safe, effective and has a low incidence of recurrence and morbidity.
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- 1. Terada N, Arai Y, Kinukawa N, Terai A. The 10- year natural history of simple renal cysts. Urology 2008; 71: 7-12.
- 2. Chang CC, Kuo JY, Chan WL, et al. Prevalence and clinical characteristics of simple renal cysts. J Chin Med Assoc 2007; 70: 486-91.
- 3. Porpiglia F, Fiori C, Billia M, et al. Retroperitoneal decortication of simple renal cysts vs decortication with wadding using perirenal fat tissue: results of a prospective randomized trial. BJU Int 2009; 103: 1532-6.
- 4. Vaidyanathan S, Hughes PL, Oo T, Soni BM. Spontaneous rupture of an infected renal cyst and external drainage through a lumbar surgical scar in a male patient with cervical spinal cord injury: a case report. J Med Case Rep 2008; 14; 2: 154.
- 5. Fontana D, Porpiglia F, Morra I, Destefanis P. Treatment of simple renal cysts by percutaneous drainage with 3 repeated alcohol injection. Urology 1999; 53: 904-7.
- 6. Roberts WW, Bluebond-Langner R, Boyle KE, Jarrett TW, Kavousi LR. Laparoscopic ablation of symptomatic paranchymal and peripelvic renal cysts. Urology 2001; 58: 165-9.
- 7. Hulbert JC. Laparoskopic management of renal cystic disease. Semin Urol 1992; 10: 239-41.
- 8. Okke AA, Mitchelmore AE, Keeley FX, Timoney AG. A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the manegement of symtomatic simple renal cysts. BJU Int 2003; 92: 610-3.
- 9. Glassberg KI. Renal dysplasia and cystic disease of the kidney. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds). Campbell’s Urology, 7th edn. W.B. Saunders, Philadelphia, PA, 1998; 1764.
- 10. Wolf J S Jr. Evaluation and management of solid and cystic renal masses. J Urol 1998; 159: 1120-3.
- 11. Raskin MM, Poole DO, Roen SA, Viamonte M Jr. Percutaneous management of renal cysts: results of a four year study. Radiology 1975; 115: 551-3.
- 12. Hanna RM, Dahniya MH. Aspiration and sclerotherapy of symptomatic simple renal cysts: value of two injections of a sclerosing agent. Am J Roentgenol 1996; 167: 781-3.
- 13. Shao Q, Xu J, Adams T, et al. Comparison of aspiration-sclerotherapy versus laparoscopic decortication in management of symptomatic simple renal cysts. J Xray Sci Technol 2013; 21: 419-28.
- 14. Demir E, Alan C, Kilciler M, Bedir S. Comparison of etanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst. J Endourol 2007; 21: 903- 5.
- 15. Kilinc M, Tufan O, Guven S, Odev K, Gurbuz R. Percutaneous injection sclerotherapy with tetracycline hydrochloride in simple renal cysts. Int Urol Nephrol 2008; 40: 609-13.
- 16. Madeb R, Feldman PA, Knopf J, Rub R, Erturk E, Yachia D. Povidone- iodine sclerotherapy is ineffective in the treatment of symptmatic renal cysts. J Endourol 2006; 20: 402-4.
- 17. Abbaszadeh S, Taheri S, Nourbala MH. Laparoscopic decortication of symptomatic renal cysts: experience from a referral center in Iran. Int J Urol 2008; 15: 486-9.
- 18. Su LM: Laparoskopic renal cyst ablation: Technique and results. In: Gill IS, ed. Texbook of Laparoscopic Urology. New York: Taylor & Francis Ltd 2006; 259-78.
- 19. Thwaini A, Shergill IS, Arya M, Budair Z. Longterm follow-up after retroperitoneal laparoscopic decortication of symptomatic renal cysts. Urol Int 2007; 79: 352-5.
- 20. Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Laparoscopic decortication of symptomatic simple renal cysts: 10- year experience from one institution. BJU Int 2006; 98: 405-8.
- 21. Atuğ F, Burgess SV, Ruiz-Deya G, Mendes-Torres F, Castila EP, Thomas R. Long -term durability of laparoscopic decortication of symptomatic renal cysts. Urology 2006; 68: 272-5.