Although they are rarely associated with complaints, benign renal cyst
s may be the cause of pain, hypertension, or other problems. Simple as
piration is rarely definitive treatment. We have had good results with
three laparoscopic approaches to cyst unroofing: transperitoneal, wit
h reflection of the colon medially or dissection through the mesocolon
and direct retroperitoneoscopy. We recommend initial percutaneous asp
iration with cytology study both to rule out malignancy and to identif
y those cysts clearly in need of unroofing.