Laparoscopic management of retrovesical cystic disease: Washington University experience and review of the literature

Background and Purpose: Recently, the laparoscopic approach to the manageme nt of seminal vesicle cysts has been described. This report outlines the Wa shington University experience and reviews the present literature to evalua te the results of the laparoscopic approach to the excision of retrovesical cysts of seminal vesicle and Mullerian origin. Patients and Methods: The hospital and office records of three patients und ergoing laparoscopic excision of seminal vesicle and Mullerian duct cyst di sease between April 1993 and March 1999 were reviewed for the operative tim e, the estimated blood loss, total hospital stay, total analgesia required postoperatively, the time to resumption of oral intake, and the postoperati ve recovery. A literature search revealed two additional reports of laparos copic management of cystic disease of the seminal vesicle, comprising only one and two patients. An additional review of the literature was performed to compare the laparoscopic procedure with the transvesical, transurethral, open transvesical, and open retrovesical approach for the management of th e disease. Results. For the three patients at Washington University, the operative tim e averaged 4 hours (range 1.8-6.1 hours), and the mean estimated blood loss was 150 mL (range 50-200 nL). The patients required a mean of 43 mg of mor phine sulfate for postoperative pain control, had a mean hospital stay of 2 .6 days, and resumed oral intake 5.8 hours postoperatively. In combination with the three other cases reported in the literature, the average operativ e time for laparoscopic retrovesical cyst excision was 2.9 hours, and the a verage hospital stay was 2.2 days. With an average follow-up of 17 months, all six patients had excellent resolution of their preoperative symptoms. T here have been no major or minor complications or any need for further oper ative therapy. Conclusion: Laparoscopic excision of retrovesical cystic disease is an effe ctive surgical procedure, associated with minimal postoperative morbidity, short hospitalization, and a rapid recovery for the patient.