ROLE AND LONG-TERM RESULTS OF LAPAROSCOPIC DECORTICATION IN SOLITARY CYSTIC AND AUTOSOMAL-DOMINANT POLYCYSTIC KIDNEY-DISEASE

Purpose: Access to retroperitoneal structures via the laparoscope has become established for various conditions. This minimally invasive app roach has distinct advantages over conventional open surgery. We docum ent our experience with laparoscopic cyst decortication for diseases o f the kidney, including simple and complex cysts, multiple cysts and a utosomal dominant polycystic kidney disease. Materials and Methods: We retrospectively reviewed the records of 17 patients who underwent a t otal of 20 procedures. Cases were categorized as polycystic kidney dis ease and nonpolycystic kidney disease. Factors analyzed were estimated blood loss, length of surgical procedure, hospital stay and complicat ions. Followup included radiographic studies (computerized tomography and/or renal sonography) and patient subjective pain relief, as determ ined by clinical records and telephone interview. Results: Nine and 11 procedures were done for nonpolycystic kidney disease and polycystic kidney disease, respectively. Of the 8 patients with polycystic kidney disease 3 underwent repeat procedures, Followup was 3 to 63 months (a verage 26), All patients with simple cysts who were treated for pain w ere pain-free at the latest-followup. Of the 10 procedures 9 (90%) per formed for pain relief in polycystic kidney disease successfully produ ced immediate pain relief, Pain-free status decreased with time with 7 of 8 (87.5%) pain-free after 6 months, and 5 of 7 (71.4%) at 1, 4 of 6 (66.7%) at 2 and 1 of 4 (25%) at 3 years. A repeat operation success fully relieved recurrent pain in 2 of 3 cases (66.7%). Of the 7 patien ts with polycystic kidney disease who underwent surgery for pain relie f 5 (71%) are currently pain-free. Conclusions: Laparoscopic renal cys t decortication is an effective minimally invasive treatment for painf ul simple cysts, It is also effective for short to intermediate pain r elief in autosomal dominant polycystic kidney disease. Long-term follo wup suggests that a repeat procedure may be necessary to maintain adeq uate control of symptoms in polycystic kidney disease.