Robotic Cyst Decortication

Robotic Kidney Surgery for Renal Cysts

Cysts can form in the kidney for many reasons. Most of these growths are non-cancerous and require no further intervention. In some instances, however, a cyst may enlarge to the point that it causes pain or obstructs the kidney. Cysts may also become infected or bleed. In addition, a cyst that at one time appeared benign may change its shape or features to the extent that a malignancy is suspected. For any of these reasons, a type of robotic kidney surgery known as a renal cyst decortication (and sometimes a renal biopsy) may be required. Minimally-invasive approaches, including laparoscopy and robotic surgery, are ideal for this relatively simple procedure. No large incisions are needed, direct visualization of the cyst and/or kidney is provided, and tissue for the pathologist can be readily obtained for more detailed evaluation. In addition, an ultrasound probe can easily be placed through one of the ports for a high-resolution examination of the remaining part of the kidney.

How Robotic Cyst Decortication is Performed

After the patient is anesthetized, four ports are put in place using quarter-inch incisions, and the robot's camera and three instrument arms are inserted through the ports. The surgeon uses the instruments to completely expose the surface of the cyst, and cyst fluid is aspirated (withdrawn through a special needle) for cellular analysis. The cyst is then cut out and sent to the pathologist for evaluation. If necessary, the base of the cyst is biopsied as well. To prevent recurrence of the cyst, the fat that surrounds the kidney is placed in the crater where the cyst was located. If a cyst is determined to be malignant, we will remove it in another robotic kidney surgery procedure known as partial nephrectomy.

Advantages of Robotic Cyst Decortication

Less post-operative pain. The small incisions used for this form of robotic kidney surgery are considerably less painful than the larger abdominal incision used for open surgery. This is confirmed by data comparing minimally-invasive cyst decortication to the open procedure, which indicates that patients undergoing robotic kidney surgery use significantly less pain medication.
Shorter hospital stay and recovery. Most patients leave the hospital within 24 hours after robotic cyst decortication and are able to resume normal activities within 1 to 2 weeks.
Excellent outcomes. Minimally-invasive approaches to cyst decortication have a demonstrated success rate of greater than 95% in patients with low complication rates. Cyst decortication also offers potential advantages over percutaneous (through the skin) drainage using image guidance. The percutaneous technique does not allow direct visualization of the cyst, doesn't provide a large sampling of tissue, and has a higher incidence of recurrence.

Robotic Cyst Decortication at NYULMC

This procedure is done laparoscopically and robotically at NYU Langone Medical Center with equally good results. These minimally-invasive approaches are the preferred treatment option for symptomatic cysts.

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