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Paper text:
hydatid cysts are rare in the urinary tract ( 2% of all hydatid disease ) as are isolated cysts of the pelvis .
the retrovesical location of these cysts makes surgical excision fraught with potential complications such as bladder and bowel injury and denervation of the bladder .
the palanivelu hydatid system ( phs ) is a recently described device that allows removal of the internal contents and the endocyst without the need for excising the entire cyst .
this has potential advantages for cysts located deep in the pelvis , and we describe the first case in the literature of laparoscopically treating a pelvic hydatid cyst with the phs .
there were no abnormal physical or laboratory findings , no mass was palpable on a rectal examination .
an x - ray of the abdomen showed the presence of a calcified mass around the right seminal vesicle [ figure 1 ] . a ct scan of the abdomen and pelvis confirmed an isolated well - defined lesion ( 6.5  5.6 cm ) in the right hemi pelvis with parenchymal calcification , internal septae , and debris suggestive of hydatid cyst ; adherent to both the bladder and rectum [ figure 2 ] .
his serology for echinococcus ( igg by enzyme - linked immunosorbent assay system ) was negative .
plain x - ray showing calcified mass in the pelvis axial computerized tomogram showing calcified pelvic hydatid adherent to the urinary bladder and the rectum with a diagnosis of retrovesical hydatid cyst , the patient was started on oral albendazole ( 15 mg / kg / d in two divided doses ) and scheduled for laparoscopic removal . in the supine position , four transperitoneal ports were used , a 12- mm camera port above the umbilicus in the midline , two pararectal ports ( 12 mm , 5 mm ) below the umbilicus and one laterally placed ( 5 mm ) in the right iliac fossa .
the cranial - most part of the cyst that was directly visible on laparoscopy was thickly calcified and adherent to the sigmoid colon and the bladder .
the ectocyst in this region was separated from these two structures circumferentially till a noncalcified part was identified on the anterior surface .
betadine - soaked gauze was packed around the cyst , and the phs was inserted into the cyst thorough a 2-cm suprapubic incision .
the contents of the cyst were aspirated , and hypertonic saline was instilled into the cavity as a scolicidal agent .
. the calcified cap of the ectocyst was laparoscopically excised , and the visualized cavity was again scraped and aspirated .
the operative time was 3 h , and the blood loss was 120 ml . there were no complications , and the patient was discharged on day 2 with advice to continue albendazole for 3 weeks .
while traditional surgical approaches have focussed on complete excision , recent reports support aspiration and removal of endocyst as being adequate for management .
the major concerns with surgery for hydatid disease were due to spillage of highly immunogenic contents leading to anaphylactic reactions and a possibility of disseminated hydatidosis due to implantation of the spilled scolices .
traditional surgery thus required total or partial excision of the cyst , without spillage of contents but is associated with a wide range of complications .
the phs has primarily been described for the management of hepatobilliary hydatid cysts where complete excision was extremely difficult .
it allows minimally invasive management with low chances of spillage of fluid or injury to adjacent organs .
it has not previously been described for hydatid cysts of the pelvis or the urinary tract .
the use of this technique in the pelvis , particularly for lesions with dense adhesions to surrounding structures , allows a safe minimally invasive option to the existing surgical techniques .
hydatid cysts of the retrovesical region are rare . 
 they are often adherent to the adjacent bowel and bladder , and complete removal is associated with potential injuries . 
 the palanivelu hydatid system allows minimally invasive treatment of hydatid cysts with no adjacent organ injuries . 
 we describe the laparoscopic management of a pelvic hydatid cyst using this system .