Contraindications and patient preparation are identical to those described for nephrostomy insertion (see Chapter 3g—Neph-rostogram). A single dose of a prophylactic antibiotic agent must be administered.
• A 21-22-gauge needle is inserted percutaneously under local anesthesia (1% lidocaine)
• Laparoscopic cyst de-roofing requires a general anesthetic
• When using a needle, cyst localization is achieved using a combination of USS (most common), CT, or fluoroscopy
• Once the cyst is punctured, the fluid is aspirated
■ Simple cyst fluid is clear and straw-colored
(i) Hemorrhage into a simple cyst
(ii) Traumatic puncture
(iv) Complex/malignant cyst
• Although many operators will terminate the procedure at this stage, injection of 1-2 ml of contrast into the cyst may help clarify the anatomy
• If no aspiration is possible, in spite of correct placement, the mass is assumed to be solid in consistency (about 25% will eventually prove to be malignant)
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