Postoperative Complications

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.

Two postoperative complications that are worthy of special mention are perinephric hematoma and urinoma. To reduce the occurrence of postoperative bleeding and hematoma, meticulous hemostasis should be confirmed at the conclusion of renal cyst ablation. As high carbon dioxide insufflation pressures can mask ongoing bleeding, the intra-abdominal carbon dioxide pressures should be reduced to 8 to 10 mmHg when assessing for bleeding points.

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.

Recurrence of a renal cyst can occur due to incomplete resection of the cyst wall due to surrounding anatomy (e.g., peripelvic cysts and autosomal dominant polycystic kidney disease) or incomplete ablation of all renal cysts. As mentioned previously, the use of intraoperative laparoscopic ultrasound can improve the safety and thoroughness of renal cyst ablation, even of deep-seated cysts. In addition, suture fixation of perirenal fat or a wick of omentum can prevent cyst fluid reaccumulation.

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 (Fig. 4).

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