Complications of 2,775 urological laparoscopic procedures: 1993 to 2005
Sompol Permpongkosol1, Richard E Link, Li-Ming Su
1Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Purpose:
We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period.
Materials And Methods:
A retrospective chart analysis was performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher's exact and chi-square tests.
Results:
A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05).
Conclusions:
The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.
