Adjacent Organ Injury

As in any laparoscopic renal procedure, injury to surrounding structures such as the bowel, spleen, liver, pancreas, pleura, and adrenals can occur.

Use of a preoperative bowel preparation especially in more challenging cases such as autosomal dominant polycystic kidney disease can decompress the bowel, improve visualization, and reduce the chance of iatrogenic injury from laparoscopic instrumentation. During mobilization of the colon and small bowel, the use of elec-trocautery should be minimized to avoid accidental cautery injury to the bowel and subsequent delayed bowel perforation. During a right-sided procedure, great care must be taken during the dissection of the duodenum. Use of electrocautery or careless sharp dissection around the duodenum can result in duodenal injury and catastrophic consequences.

If recognized, a small bowel injury may be repaired laparoscopically in multiple layers with interrupted 3-0 silk sutures; however, a bowel resection may be required.

A general surgery consultation can be obtained to help assess the degree of injury and assist in its repair. Gentle blunt retraction of the liver and spleen is the rule to avoid laceration and bleeding from these organs. If bleeding occurs, a combination of pressure, argon beam coagulation, and oxidized cellulose gauze can manage most abrasion and laceration injuries to the liver and spleen.

Complications such as ileus, fever, urinary tract infection, urinary retention, atelectasis, pneumonia, cellulitis, renal insufficiency, neuromuscular injury, incisional hernia, transfusion, recurrence of cyst, persistence of pain, deep venous thrombosis, and pulmonary embolism can occur following laparoscopic renal cyst ablation.

To avoid the occurrence of urinoma, every attempt should be made to avoid inadvertent entry into the collecting system when performing renal cyst ablation and to repair overt injuries if they occur.

Persistence of pain following ablation of a solitary renal cyst may indicate an incorrect diagnosis as to the initial cause of pain. It is therefore recommended that patients undergo an initial trial of cyst aspiration with laparoscopic ablation reserved only for those patients whose cyst and symptoms recur.

Success of laparoscopic renal cyst ablation as defined by relief of symptoms (i.e., symptomatic success) averaged 97% when comparing all series, with 92% of patients showing no evidence of cyst recurrence on follow-up imaging studies (i.e., radiographic success).

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