Laparoscopic Renal Cystectomy

In 1901, German surgeon Kelling first used Nize cystoscopy for abdominal examination. With the improvement and development of endoscopy, laparoscopic surgery has been widely used in the diagnosis and treatment of general surgery, obstetrics and gynecology and urology. In recent years, the development of laparoscopic surgery in urology has been even more encouraging. It has the advantages of small damage, less postoperative pain, quick recovery, etc. It is more and more accepted and applied by patients and urologists. In the 1960s, laparoscopy was only used for the diagnosis of patients with intra-abdominal cryptorchidism and pseudo-hermaphroditism and high ligation of spermatic vein. In 1979, Wickman used laparoscopic retroperitoneal ureterolithotomy. In 1985, Eshghi used laparoscopic pelvic heterotopic renal incision. In the 1990s, Glayman used laparoscopic nephrectomy and Parra used abdominal cavity. Mirror pelvic lymphadenectomy and biopsy. At present, laparoscopic surgery has been widely used in the treatment of various diseases of urology, such as complete seminal vesicle resection, ureteral obstruction after gynecological surgery, bladder diverticulectomy, renal cyst drainage, renal cyst decompression, Postoperative renal cyst drainage, urinary incontinence bladder neck suspension, ureteropelvic ureteroplasty, ureteral anti-reflux surgery, nephrectomy, prostatectomy and even radical prostatectomy. Due to the application of B-ultrasound and CT examination, many asymptomatic renal cysts were detected. Some renal cysts are not specially treated because of their small size or special parts; some of the renal cysts are guided by B-guided cysts; others are treated with open surgery because of large cysts, special sites or recurrence after puncture. Because of the large open surgical injury, the application of laparoscopy is more reasonable treatment, with the characteristics of small damage, quick recovery and good curative effect. Treatment of diseases: renal cysts Indication 1. Simple renal cyst, which is compressed by the renal parenchyma and affects kidney function. 2. Isolated multi-atrial renal cyst. 3. Cyst around the renal pelvis, pseudocyst around the kidney with infection, resulting in urinary tract obstruction. 4. Large cysts of polycystic kidney disease oppress the renal parenchyma, causing urinary tract obstruction. Contraindications There are no absolute contraindications. However, patients with benign cysts who have severe bleeding tendency, as well as patients with systemic conditions that are difficult to tolerate surgery, may be relatively contraindicated. Preoperative preparation 1. Preoperative B-ultrasound and pyelography confirmed the cyst site and its anatomical relationship. 2. Use antibiotics when combining infections. Surgical procedure 1. Transabdominal renal cystectomy (1) The steps of puncture, artificial pneumoperitoneum and placement of the cannula are the same as those of nephrectomy. (2) Open the lower peritoneum of the colon (lowering) and pull the colon liver (or spleen) to the medial or upper side. (3) Separation of renal fat and exposure of renal cysts. (4) Cut the cyst wall and aspirate the cyst fluid. (5) The cyst wall was removed by 0.5 cm from the renal parenchyma. Check for no bleeding, pull out the laparoscope, manipulator and cannula one by one, and suture the puncture hole. 2. Transperitoneal approach surgery (1) The position of the trocar is designed to be the same as nephrectomy. (2) The establishment of the retroperitoneal operation gap is the same as nephrectomy. (3) renal cyst separation, cyst wall resection and abdominal cavity renal cyst surgery.