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Routine postoperative chest x-ray following laparoscopic nephrectomy.
Scott D Simon1, Erik P Castle, Robert G Ferrigni
1Laparoendoscopic and Reconstructive Surgery, Mayo Clinic, Scottsdale, Arizona 85255, USA.
Summary
Routine postoperative chest x-rays are not necessary after uncomplicated laparoscopic nephrectomy. Pneumothorax is typically identified by clinical findings or intraoperatively, not routine imaging.
Area of Science:
- Urology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Laparoscopic nephrectomy is a common surgical procedure.
- Pneumothorax is a potential complication following abdominal surgery involving the diaphragm.
- The necessity of routine postoperative chest x-rays (CXR) to detect pneumothorax after laparoscopic nephrectomy remains debated.
Purpose of the Study:
- To evaluate the requirement for routine postoperative chest x-rays (CXR) after uneventful laparoscopic nephrectomy.
- To determine if routine CXR is effective in ruling out pneumothorax in this patient population.
Main Methods:
- A retrospective review of 308 laparoscopic nephrectomy cases performed between June 1999 and May 2003.
- Analysis of 186 postoperative CXRs obtained routinely (183) or for known diaphragmatic injuries (3).
- Comparison with 122 cases where routine CXRs were not performed, noting subsequent imaging for clinical indications.
Main Results:
- Four pneumothoraces were identified among 308 cases.
- Three pneumothoraces were associated with intraoperative diaphragmatic injuries.
- One pneumothorax, detected due to postoperative shoulder pain (not routine CXR), resolved spontaneously. No incidental pneumothoraces were found on routine CXRs.
Conclusions:
- Pneumothorax was identified either intraoperatively or via postoperative clinical assessment.
- Routine postoperative chest x-rays did not alter patient management in this series.
- Routine postoperative chest x-ray is deemed unnecessary for uncomplicated laparoscopic nephrectomy.