Collecting System Injury

Injury to the collecting system can occur during aggressive biopsy and fulguration of the base of the cyst wall or during attempts at cyst wall excision of a peripelvic or autosomal dominant polycystic kidney disease cysts.

When biopsy of the cyst base is indicated, only superficial samples should be taken especially in the case of peripelvic cysts or cysts located close to the collecting system. Reference to preoperative radiologic films may be helpful in assessing the depth of the cyst and its proximity to the collecting system. Direct coagulation of the collecting system should be avoided. As mentioned previously, placement of an open-ended ureteral stent at the start of the operation especially in the treatment of peripelvic or autosomal dominant polycystic kidney disease cysts can help identify the precise location of a collecting system injury and facilitate its repair.

The open-ended ureteral stent can be converted at the end of the case to an indwelling ureteral stent, which should be placed under fluoroscopic guidance to confirm proper positioning within the collecting system.

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

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.

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