Elsevier

Urology

Volume 63, Issue 1, January 2004, Pages 27-32
Urology

Adult urology
Complications of abdominal urologic laparoscopy: longitudinal five-year analysis

https://doi.org/10.1016/j.urology.2003.10.003Get rights and content

Abstract

Objectives

To analyze complications of abdominal laparoscopic surgery of the urinary tract at a single institution during a 5-year period.

Methods

From 1996 to 2000, we identified 894 abdominal laparoscopic procedures performed at a single institution: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections, 31 renal cyst ablations, 18 adrenalectomies, and 37 other abdominal procedures. The charts were retrospectively reviewed for complications, which were classified as operative, postoperative, or medical. Complications were correlated with patient age and American Society of Anesthesiologists score. Statistical analysis was performed with Fisher's exact test and chi-square tests.

Results

A total of 118 complications (13.2%) occurred. Two patients (0.2%) died. As a result of operative complications, the procedure of 13 patients (1.5%) was converted to an open one. As a result of postoperative complications, 13 (1.5%) underwent operative and 6 (0.7%) nonoperative intervention. The most common intraoperative complications were vascular (n = 23), adjacent organ (n = 10), and bowel (n = 9) injuries. The most common postoperative complications were neuromuscular pain (n = 12), hematoma (n = 11), urine leak (n = 7), and wound infection (n = 7). The differences in the annual complication rates for all procedures did not attain statistical significance (P = 0.5). Among all procedures, excluding live donor nephrectomy, complications of any kind correlated with a greater patient American Society of Anesthesiologists score (P = 0.01).

Conclusions

Rather than decreasing, the overall incidence of laparoscopic complications did not change significantly during a 5-year period at our institution. The factors contributing to this observation likely included the progression of inexperienced individual surgeons through the learning curve, the introduction of new, more sophisticated laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average complication rate for urologic laparoscopy at a large-volume, academic training center.

Section snippets

Material and methods

In July 1993, we instituted a laparoscopic urologic surgical program at our institution that included the establishment of an operative team, development of a specialized operative space, and procurement of advanced laparoscopic equipment. From January 1, 1996 to January 1, 2001, 894 abdominal laparoscopic procedures were performed: 600 nephrectomies (live donor, simple, radical, nephroureterectomy, and partial), 112 pyeloplasties, 61 renal biopsies, 35 retroperitoneal lymph node dissections,

Results

Complications occurred in 118 (13.2%) of 894 cases. Two patients (0.2%) died: one of multisystem organ failure after laparoscopic nephrectomy complicated by intraoperative bowel injury and one of intestinal ischemia (determined at autopsy to be unrelated to the surgery) after uncomplicated laparoscopic nephrectomy. Forty-two of the complications (4.7% of all cases) were operative, 60 (6.7%) were postoperative, and 16 (1.8%) were medical. The most common operative complication was vascular

Comment

The dissemination of laparoscopic techniques in urology demands that complications from laparoscopic procedures be assessed so that efforts to minimize future complications may be taken, management of complications improved, and patients appropriately counseled regarding the operative risks. The complication rates for urologic laparoscopy vary significantly from one series to another, ranging from 4.4% to 19%.3, 4, 5, 6, 7, 8, 9, 10, 12, 13 Explanations for this disparity include variable

Conclusions

The incidence and types of complications for laparoscopic procedures did not change significantly during a 5-year period at our institution. We believe this trend reflects individual surgeons progressing through the laparoscopic training curve, the introduction of new laparoscopic procedures, and stable rates of patient comorbidity. This experience may represent the average laparoscopic complication rates one may expect at a large-volume, academic training center. Multi-institutional studies of

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