The laparoscopic isolated hypobaric technique that we developed and use is safe and feasible for almost all kinds of hepatic and extrahepatic abdominal hydatid cysts.
The main surgical maneuvers (puncture, parasite neutralization, and complete evacuation) were performed through an assembled transparent cannula, in which a vacuum was created, while its tip adhered firmly to the cyst wall. Following evacuation of the cyst contents, we attempted to perform partial pericystectomy, omentoplasty, and closed-suction drainage.
We have previously described the technique of the laparoscopic isolated hypobaric management of echinococcal cysts in experimental and clinical settings.
The principle of the technique, in brief, is to puncture, aspirate, irrigate, and evacuate the contents of the parasitic cyst through a large-diameter transparent cannula, which enables supervision from outside.
The cannula has a beveled tip that is apposed firmly to the surface of the cyst by suction applied through its lateral stopcock, to create a "vacuum" (hypobaric) atmosphere inside the cannula, which then serves as an isolated working unit.
The isolated hypobaric laparoscopic technique described provides a safe and efficacious approach to almost all types of abdominal hydatid cysts and takes advantage of the recognized benefits of the laparoscopic approach.