Right Transperitoneal Laparoscopic Technique

For a right-sided transperitoneal laparoscopic renal cyst ablation, trocar configuration is the mirror image of that used for a left-sided technique (i.e., the second 10/12-mm trocar is placed lateral to the right rectus muscle with all other trocars remaining the same). The ascending colon is reflected medially and for cysts located near the hilum, reflection of the duodenum may be required. A combination of blunt and sharp dissection of the attachments between the duodenum and kidney (Kocher maneuver) is performed with avoidance of electrocautery. For cysts located along the superior pole of the kidney, sharp release of the coronary ligament of the liver allows for anterior retraction of the right lobe of the liver for exposure to the upper pole of the kidney. A 3-mm or 5-mm additional trocar may be placed two to three fingerbreadths superior to the existing 5-mm trocar to allow for insertion of a laparoscopic instrument or grasper for liver retraction. The subsequent steps follow that of a left-sided dissection. Figure 16 demonstrates the computed tomography images of a patient with bilateral, multiple renal cysts causing hydronephrosis and symptoms of right flank pain, who underwent right laparoscopic renal cyst ablation of a parapelvic and large peripheral cyst with prompt resolution of obstruction and symptoms.

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