Complications of retroperitoneoscopic surgery at one centre

To evaluate the complications of retroperitoneoscopic urological surgery at one centre and to analyse their causes and means of prevention.

The procedural details and complications were analysed retrospectively in 316 patients (aged 4-88 years) who underwent retroperitoneoscopic urological surgery between March 1994 and January 2000 at our centre. Nephrectomies and nephroureterectomies for benign and malignant diseases were the most common procedures. Other indications included urolithiasis, adrenal diseases, pelvi-ureteric junction obstruction, chyluria, retrocaval ureter and malignant retroperitoneal lymph node enlargement. The specimens were retrieved intact by enlarging the port sites.

The mean (range) operative duration was 104.9 (30-400) min, the blood loss 130.86 (25-1200) mL and the hospital stay 3.2 (1-10) days; 3.5% of the patients had a major complication, including seven vascular injuries, five of which required immediate conversion to open surgery. Four patients (1.2%) had other major complications including colonic injury, retroperitoneal collections and incisional hernia. There were 50 minor complications (15.8%) of which peritoneal tears (17) were the commonest. Port-site infections and subcutaneous emphysema contributed 2.2% each.

As the stages of retroperitoneoscopic surgery become standardized and the outcome predictable, it is rapidly becoming accepted as an important method of treatment. The complications are few and predominantly minor. Increasing experience leads to a decrease in the complication rates. Individual surgeons can identify the common complications in their practice, ascertain the possible causes and devise methods of prevention.