The aim of this paper was to assess long-term results of transperitoneal laparoscopic fenestration in the treatment of symptomatic simple renal cysts. Fifteen consecutive patients (7 men, 8 women), with a mean age of 51 years (range, 36-79 years), underwent transperitoneal fenestration of simple renal cysts (SRC) at our institution from 1994 to 2001. Data were collected by reviewing patients' clinical files, conducting telephone interviews regarding symptoms, and followup renal ultrasonography (US). There were 15 symptomatic cysts (10 parenchymal, 5 peripelvic) ranging in diameter from 3.5 to 20 cm (mean, 8 cm). All patients had lumbar pain and in four (26.6%) the collecting system was compressed by the cysts. Fenestration was carried out laparoscopically in all patients. There was no mortality and no postoperative complications were recorded. No malignancies were detected at final histopathology. Mean length of stay was 2.5 days. All patients were available for long-term followup. At a mean of 60 months (range, 22-93 months) from surgery, three patients (20%) complained of slight discomfort in the lumbar area not requiring any analgesic. No recurrence of the cysts was seen on US. Two asymptomatic patients (13.3%) developed additional cysts originating from sites different than the one operated on. Laparoscopic fenestration of SRC is safe and effective in the long term to relieve patients from symptoms.