Narrative review of laparoscopic management of hepatic cysts

Abstract

: Hepatic cysts are a common and often asymptomatic finding. In this review we will discuss the diagnosis and treatment of hepatic cysts with a specific focus on minimally invasive surgical approaches. Most simple cysts are asymptomatic and do not require intervention. As cysts increase in size they may cause a range of symptoms including satiety, fullness, a palpable mass, and rarely bleeding or secondary infection. Surgical approaches are reserved for symptomatic lesions, and hydatid disease. It is important to rule out bacterial infection (abscess) and neoplasm in the work up of hepatic cysts. While cysts are often detected by ultrasound, Computed tomography and Magnetic Resonance Imaging are the primary modes of assessment for these lesions. Most cysts can be managed by unroofing or marsupialization alone, with formal liver resection rarely required. Minimally invasive surgery (MIS) techniques have been described for many years including laparoscopic and recently, robotic approaches. Hydatid cysts require special attention to control of contents to avoid anaphylaxis but can also be managed laparoscopically. Laparoscopic and/ or robotic surgery can be performed safely and is effective in the treatment of cystic disease of the liver. Mortality should be below 1%, and overall morbidity less than 10%. Recurrence rates for simple cysts are generally below 10%, however polycystic liver disease (PLD) does have a higher recurrence rate after marsupialization than simple cysts.