title: Is it safe and effective to treat complex renal cysts by the laparoscopic approach?
abstract: OBJECTIVE
  Bosniak III and IV renal cysts have low mortality potential, and little is reported regarding the feasibility and safety of managing such tumors by laparoscopy and its comparison with open surgery. We report on the experience with 37 complex renal cysts managed in the era of laparoscopy.
  
  
  METHODS
  A retrospective analysis of a prospective database from all patients with renal tumors who were operated on at our institution was evaluated after Institutional Review Board approval. The database comprises information for demographic, clinical, imaging, preoperative, intraoperative, histologic, and follow-up data. A comparison among all performed approaches was done for demographic, American Society of Anesthesiologists classification, operative time, estimated blood loss, ischemia time, hospital stay, oncologic and survival rate. The cysts removed by laparoscopic partial nephrectomy were compared with the solid tumors removed by the same approach at the same period.
  
  
  RESULTS
  The database included 407 patients with renal tumors who were operated on from 2000 to 2009 at our institution. In 36 patients of the total cohort, there were 37 complex renal cysts. No patients with preoperative Bosniak type I or II underwent surgery. Of the cysts, 60% were Bosniak IV, and 86% were confirmed as malignant; 40% were Bosniak III, and 44% were confirmed as malignant. Laparoscopic partial nephrectomy was performed in 67.5%. The tumor size and hospital stay were significantly different in the laparoscopic group. No cyst spillage occurred either by laparoscopy or by the open approach, and no tumor recurrence was found in a mean follow-up of 43.7 months with overall survival of 100%.
  
  
  CONCLUSIONS
  Laparoscopic surgery for complex cysts is safe, feasible, and effective. Nevertheless, regardless of surgical approach, patients with complex renal cysts have excellent overall survival with short-term follow-up.
authors.affiliation: Division of Urology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Thomé
authors.initials: T
authors.lastname: Pinheiro
authors.forename: Fabio
authors.initials: F
authors.lastname: Sepulveda
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Natalin
authors.forename: Esteban
authors.initials: E
authors.lastname: Metrebian
authors.forename: Rebecca
authors.initials: R
authors.lastname: Medina
authors.forename: Suzan M
authors.initials: SM
authors.lastname: Goldman
authors.forename: Valdemar
authors.initials: V
authors.lastname: Ortiz
authors.forename: Cássio
authors.initials: C
authors.lastname: Andreoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003710:Demography; D005260:Female; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome