Laparoscopic treatment for renal hydatid cyst

199 JOURNAL OF ENDOUROLOGY

Volume 20, Number 3, March 2006

© Mary Ann Liebert, Inc.

Laparoscopic Treatment for Renal Hydatid Cyst

REDOUANE RABII, M.D., MOHAMED HICHAM MEZZOUR, M.D., HICHAM ESSAKI, M.D., HAMID FEKAK, M.D., ABDENBI JOUAL, M.D., and FETHI MEZIANE, M.D.

ABSTRACT

A multivesicular hydatid cyst was removed from the left kidney of a 26-year-old woman by retroperitoneal laparoscopy to avoid contamination of the abdominal cavity. A scolicidal agent (20% hypertonic saline) was injected around the kidney initially and then instilled into the cyst after the contents had been evacuated.

There were no complications and no anaphylactic shock. This appears to be the first reported case of treat- ment of renal hydatid cyst by laparoscopy.

INTRODUCTION

S

CASE REPORT

A 36-year-old woman with an unremarkable medical history presented with left lumbar pain. Physical examination revealed a left abdominal mass. Abdominal ultrasonography demon- strated a left multivesicular renal cyst. The right kidney was normal. Excretory urography showed a left renal-compressive hydatid cyst. Routine serum, cytologic, and urine studies were unremarkable, but serologic testing for Echinococcus granulo- suswas positive.

The patient underwent laparoscopic resection of the hydatid cyst by a retroperitoneal approach. The patient, under general anesthesia, was placed in the lateral decubitus position. Five trocars were used. A 15-mm incision was made under the 12^th rib and the retroperitoneum entered digitally by blunt dissec- tion, pushing the peritoneum forward and allowing the other trocars to be inserted. One 10-mm and one 5-mm trocar were placed in the anterior axillary line. One 10-mm trocar (laparo- scope port) was inserted in the axillary midline above the iliac crest. One 5-mm trocar was placed under the initial incision in the posterior axillary line. A 10-mm trocar was inserted in the initial incision.

The retroperitoneal access was created without balloon di- latation. The retroperitoneal space was dissected free to iden- tify the psoas muscle.

The exploration showed a multivesicular hydatid cyst with large development on the inferior pole of the kidney, which was dissected as follows. The first step is to avoid spillage of the cyst contents using a scolicidal agent, 20% hypertonic saline, which was injected all around the cyst in the retroperitoneum.

The anterior axillary 5-mm trocar was placed into the cyst, and the contents were aspirated with a 50-mL syringe through the suction cannula (Fig. 1). A similar amount of hypertonic saline was then introduced into the cyst. Adequate exposure time (10 minutes) was provided, and then the cyst was incised and as- pirated (Fig. 2). All of the vesicular cyst and the endocyst (ger- minal layer) were removed carefully and placed in an Endobag without spillage under laparoscopic vision (Fig. 3). The En- dobag was taken out through a 10-mm trocar site (Fig. 4). The cyst was unroofed, hemostasis achieved with electrocautery, and a drain placed in the residual cavity. Oral albendazole ther- apy for 3 weeks was started after surgery.

The procedure was successful with no intraoperative com- plication or anaphylactic shock. The operative time was 120 minutes, and the hospital stay was 2 days. Pathologic and par- asitologic examination confirmed renal Echinococcus granulo- sus disease. Ultrasonographic surveillance showed a residual cavity, and serology examination was negative.

DISCUSSION

Echinococcus granulosusis one of the most important par- asitic infections in the Mediterranean countries. It supervenes

Urology Department, Ibn Rochd Hospital, Casablanca, Morocco.

in the form of cystic lesions of the liver in most cases, and lo- calization in the kidney is rare. Different therapeutic procedures have been proposed, but surgery is still the best option.² Be- cause of the good prognosis of this benign disease, a minimally invasive treatment can be used.¹However, this treatment must replicate all the principles of conventional hydatid surgery.¹

Despite widespread use of laparoscopy for a variety of uro- logic procedures, a review of literature demonstrated no re- ported cases of laparoscopic treatment of hydatid cysts³except those located in the liver, lung, and retroperitoneum.^1,3All prin- ciples used during open surgery were maintained with this lap- aroscopic approach. Conventional renal hydatid surgery re- RABII ET AL.

200

B A

B A

FIG. 2. Hydatid cyst opened.

FIG. 3. Hydatid being put in Endobag.

FIG. 1. Aspiration (A) and sterilization (B) of cyst.

FIG. 4. Extraction of Endobag from 10-mm trocar site.

quires a large lumbar incision under maximal protection by scolicidal agents around the kidney. The principles are always puncture, aspiration, irrigation, and evacuation of the contents without spillage. Several options, including partial cystectomy, marsupialization, partial nephrectomy, or nephrectomy (renal destruction) have traditionally been used. We performed mar- supialization with removal of the endocyst in an Endobag. As with many laparoscopic procedures, resection of the renal hy- datid cyst has been found to be feasible in experienced hands, offering the advantage of less pain, good cosmesis, and rapid recovery with a shorter hospital stay. With the retroperitoneal approach, we avoided contamination of the abdominal cavity.

We hope that other surgeons will consider laparoscopic treat- ment of renal hydatid cysts in similar cases to determine whether morbidity, quality of life, and recurrence are similar to or better than the results obtained with open surgery. Laparo- scopic surgery by a retroperitoneal approach is a safe option and undoubtedly has a position in the treatment of renal hy- datid cyst.

REFERENCES

1. Chowbey PK, Shah S, Khullar R, Sharma A, Soni V, Baijal M, Vashistha A, Dhir A. Minimal access surgery for hydatid cyst dis- ease: Laparoscopic thoracoscopic and retroperitoneoscopy approach.

J Laparoendosc Adv Surg Tech A 2003;13:159.

2. Nari G, Ponce O, Cirami M, Jozami J, Tablli J, Eduardo M, Fer- nando M. Five years’ experience in surgical treatment of liver hy- datidosis. Int Surg 2003;84:194.

3. Bishoff JT, Kavoussi LR: Laparoscopic surgery of the kidney. In:

Walsh PC, Retik AB, Vaughan ED, Wein AJ. (eds): Campbell’s Urology, ed 8. Philadelphia: WB Saunders, 2002, p 3645.

Address reprint requests to:

Redouane Rabii, M.D.

Hassan II Medical University Rue Tarik Ibn Ziad Casablanca, Morocco E-mail:[email protected]

LAPAROSCOPIC TREATMENT FOR HYDATID CYST 201