LAPAROSCOPIC APPROACH TO HYDATID LIVER CYSTS - IS IT LOGICAL - PHYSICAL, EXPERIMENTAL, AND PRACTICAL ASPECTS

Background: In recent years attempts have been made to treat hydatid l iver cysts laparoscopically. The purpose of this study was to evaluate different aspects of this approach and to examine whether a reasonabl e model could be developed. Methods: Three different subjects were ana lyzed. In the first, physical aspects related to transmembrane pressur es were analyzed to demonstrate that evacuation of the cyst under pneu moperitoneum does not carry increased risk of spillage, and may even o ffer an advantage when the proper technique is used. In the second sub ject, an isolated liver model of a goat was used to study several tech niques for evacuating hydatid cysts without spillage. This was tested qualitatively by demonstrating scolices in the fluid medium around the isolated liver after surgical manipulations. In the third subject, th e implication of the technique was evaluated in human patients. Result s: According to basic physical assumptions, the following conclusions were reached: (1) The increase in intracystic pressure is equal to or less than the increase in intraperitoneal pressure after pneumoperiton eum. (2) Aspiration of parasitic cysts by laparoscopic needle through a large cannula under ''vacuum'' or by sealing the cannula and adherin g it to the liver by cyanoacrylate or fibrin glue was found to be very safe. Simple needle aspiration failed to prevent spillage. (3) A new transparent cannula 18 mm in diameter with a beveled tip was designed that enables good accessibility to liver cysts and safe evacuation eve n of huge and complex cysts. Conclusions: The novel technique to manag e hydatid liver cysts, described in the study, is feasible, sensible, and safe. The isolated goat liver containing hydatid cysts can be used as a reliable animal model to test new techniques in the future.