Laparoscopic treatment of liver hydatid cysts.

We report the laparoscopic use of a novel perforator-grinder-aspirator apparatus, specifically designed for the evacuation of hydatid cysts. Eleven hepatic hydatid cysts in six patients were treated by laparoscopic technique using this tool, which penetrates the cyst mainly by opening a hole in the cyst wall, grinds the particulate, and sucks it all out; classic surgical aspirators are almost always blocked by daughter cysts and laminated membranes. If the cyst is small, management of the cavity is achieved by simple drainage; otherwise, vacuum obliteration with the application of -250-mbar negative pressure may be necessary. High vacuum obliterates the cystic cavity by clinging to the opposing cyst walls. In the postoperative period, none of these patients had bile drainage. In the following 6 to 20 months period, computed tomography (CT) and ultrasound examinations revealed progressive decrease in the size of seven cysts and disappearance of the lesions in five cysts. We therefore conclude that laparoscopic treatment of hepatic hydatid cysts can be easily and effectively accomplished by using this novel instrument. Obliteration of the cystic cavity by high vacuum is a time-saving procedure that is easy to perform and that reduces or totally eliminates bile drainage.