Objective To investigate the optimal procedure and its safety and feasibility for the treatment of simple renal cysts by comparing the treatment effects of posterior laparoscopic decortication and transumbilical single-port laparoscopic decortication (LESS-RRC). Methods We retrospectively analyzed the clinical data of 77 patients with simple renal cysts (53 patients undergoing posterior laparoscopic decortication and 24 patients undergoing LESS-RRC) admitted to our department between October 2009 and March 2011, and compared the clinical efficacy, operation time, intraoperative bleeding and postoperative recovery of the two procedures. Results All 77 surgeries were completed successfully. The mean operative time was 46.98±10.99 min in the posterior laparoscopic group and 32.33±11.94 min in the uniportal laparoscopic group, with a significant difference between the two groups (P<0.05 [Microsoft user 2]), the mean intraoperative bleeding volume was 30.67±15.47 ml in the posterior laparoscopic group, the mean indwelling drainage tube was 2.6 d, and the mean postoperative hospital stay was There was no statistically significant difference between the two groups (P>0.05), and no postoperative complications such as abdominal wall hernia. 77 patients were followed up for 4 to 20 months without recurrence. Conclusion Transumbilical single-port laparoscopic renal cyst decompression is similar in efficacy compared with posterior laparoscopic renal cyst decompression, but the former has significantly shorter operative time and the advantages of concealed incisional scar and good cosmetic effect, which is a new clinical option for the treatment of simple renal cysts[Microsoft User 3] . Simple renal cyst is a common and frequent disease in clinical urology, and the preferred procedure for treatment is laparoscopic renal cyst decompression, and with the development of minimally invasive surgery, transumbilical single-hole laparoscopic surgery has begun to attract attention. In our department, transumbilical single-port laparoscopic surgery has been used to treat simple renal cysts since October 2009, and it has been compared with conventional retroperitoneoscopic renal cyst decompression, which is firstly reported as follows. Clinical data and methods 1.1 Clinical data Seventy-seven patients were diagnosed with simple renal cysts preoperatively by abdominal ultrasound, CT scan and enhancement of both kidneys and intravenous pyelogram (IVU) examination, among which 12 cases were accompanied by lumbar discomfort and the rest were found by physical examination. In the posterior laparoscopic group, 53 patients, 23 males and 30 females, with an average age of 41 years, had cysts located on the left side in 19 cases and on the right side in 34 cases, with a maximum diameter of 8.2 cm on average; in the single-port laparoscopic group, 24 patients, 13 males and 11 females, with an average age of 34 years, had cysts located on the left side in 17 cases and on the right side in 7 cases, with a maximum diameter of 7.9 cm on average. all patients underwent routine preoperative examination, with no significant cardiopulmonary or abdominal All patients underwent preoperative routine examination and had no significant abnormalities in the heart, lungs and abdomen [Microsoft User 4]. 1.2 Equipment The posterior laparoscopic renal cyst decompression was performed with a general laparoscope and operating instruments; the LESS-RRC was performed with single-hole laparoscopic instruments and 30° Olympus standard laparoscope provided by Cambridge Endo, USA and Hangzhou Tonglu Nanyu Medical Equipment Factory, China. 1.3 Surgical method Posterior laparoscopic renal cyst decompression: endotracheal intubation anesthesia was used, and the patient was placed in the fully healthy side lying position with the lumbar region. The posterior abdominal cavity was established, Gerota’s fascia and renal fat capsule were incised on the surface of the cyst, the cyst was freed, the cyst wall was lifted, most of the cyst wall was circumferentially excised at 0.5 cm from the renal parenchyma, and after hemostasis by marginal electrocoagulation, the cyst wall was removed and the lateral abdominal incision was closed with sutures. Surgical procedure: Single-port laparoscopic instruments were used to perform the surgery. The renal cyst was located, the retroperitoneum and renal Gerota’s fascia and renal fat capsule were incised on the surface of the cyst, the cyst was freed, and the rest of the steps were the same as for retroperitoneoscopy, and the umbilicus was closed with absorbable sutures cosmetic surgical style sutures to close the incision. 2 Results The surgery was completed successfully in both groups, with less intraoperative bleeding and no damage to surrounding organs and intermediate opening. Posterior laparoscopic group: average operation time 46.98±10.99min, average intraoperative bleeding 30.67±15.47ml, indwelling drainage tube 2.6d, postoperative hospital stay 2.7d; single-hole laparoscopic group: average operation time 32.33±11.94min, average intraoperative bleeding 29.5±10.23ml, indwelling drainage tube 2.3d, postoperative The data of each group were tested by t-test, and there was no significant difference between the groups except for the operative time (P<0.05) (P>0.05). See Table 1. Table 1 Comparison of various surgical indicators between two groups of cases Group n Operative time Intraoperative bleeding Retained drainage tube Postoperative hospital stay (min) (ml) (d) Posterior laparoscopic group 53 46.98 ± 10.99 30.67 ± 15.47 2.6 2.7 Single-port laparoscopic group 24 32.33 ± 11.94 29.5 ± 10.23 2.3 2.5 P < 0.05 >0.05 >0.05 >0.05 >0.05 >0.05 3 Discussion (Epidemiology, diagnosis and treatment options of simple renal cysts; Simple renal cysts are the most common among renal cystic diseases, usually unilateral and solitary, with a prevalence of up to 50% in people over 50 years of age [1], and simple renal cysts usually have no clinical manifestations and are mostly found during ultrasound or CT examination by health checkup or other diseases. The simple renal cysts usually have no clinical manifestations and are mostly found during ultrasound or CT examination for health checkups or other diseases. For solitary renal cysts larger than 5 cm in diameter, puncture and sclerotherapy can be used, but the recurrence rate is high [2]. Open surgery has been gradually replaced by laparoscopy for reasons such as large trauma and slow postoperative recovery, and has now become the ideal method for treating simple renal cysts [3]. In recent years, with the development of minimally invasive surgical techniques and instruments, single-port laparoscopic surgery has gradually attracted attention. In 2009, White [6] reported 100 cases of uniportal laparoscopic surgery including renal cysts with good results. In China, Wu Gang et al [7] reported the experience of single-port posterior laparoscopic renal cyst decompression with a mean operative time of 23 min and a mean hospital stay of 1.2 d, for see postoperative complications. The follow-up was 1 to 3 months with satisfactory results. By performing 24 cases of transumbilical single-hole laparoscopic simple renal cyst decompression, we have the following experiences: ① The LESS surgical incision is located in the umbilicus, which has more folds and is treated with cosmetic surgical sutures, making the abdominal wall look incisionless and achieving a scarless and cosmetic effect on the abdominal wall. ②Adopting the homemade single-hole channel, the method is simple and easy to use, reducing medical costs. ③Reducing postoperative pain and reducing the amount of intraoperative and postoperative anesthetic drugs and analgesic drugs. ④The LESS surgical field of view is closer to that of conventional laparoscopy, which makes it easier to switch to 2-hole or 3-hole laparoscopy when excessive intraoperative bleeding or operational difficulties are encountered. ⑤Significantly reduced operative time, less damage to kidney and body, and can be done without placing drainage tube. ⑥The postoperative results are the same as those of conventional laparoscopic surgery. The main problems facing transumbilical single-port laparoscopic surgery at present are the interference between surgical instruments and the difficulty in exposing the surgical field. In order to overcome the above difficulties, we took the following measures: ① The use of elongated surgical instruments with bendable and rotatable front ends for cross-operation. The right-hand instruments operate on the left side of the operative field, while the left-hand instruments operate on the right side; (2) appropriate adjustment of the laparoscopic angle; (3) continuous improvement of the method of establishing the channel: the surgical instruments enter the abdominal cavity from both sides of the channel as far as possible, and the laparoscope enters through the lower part between them. After continuous improvement and accumulation of surgical experience, the operating time has been continuously reduced, but further innovation and improvement of single-port devices and surgical instruments are still needed. Through comparison, we found that transumbilical single-port laparoscopic renal cyst decompression has obvious advantages such as more minimally invasive, hidden surgical incision with cosmetic effect, and can achieve the same treatment effect as traditional laparoscopic surgery, which is safe and effective, and it can become a new choice for clinical treatment of simple renal cysts