Complications of laparoscopic pyeloplasty

With the development of new video-endoscopic techniques like endopyelotomy, laparoscopy and retroperitoneoscopy the treatment of UPJO has become less invasive. The complications and learning curve of laparoscopic pyeloplasty are presented together with recommendations for adequate management.

Based on the personal experience with 189 cases of retroperitoneoscopic pyeloplasty, a literature review (PubMed) was performed focussing on complication and success rates of the procedure. Intraoperative incidents were analysed using the Satava-classification, postoperative complications according to the Clavien-classification. The meta-analysis focussed on the experience of the 3 largest and 2 smaller series representing a cohort of 601 patients.

Intraoperative incidents ranged from 2.0 to 2.3% in large series, mostly without consequences for the patient including ligation of lower pole artery, loss of needle, hyperkapnia, cutting of DJ-stent, colonic injury, and port site bleeding. The conversion rate was mainly due to inability to access UPJ or to accomplish the anastomosis ranging between 0.5 and 5.5%. Postoperative complications occured between 12.9 and 15.8% in large series. A total of 5.4-10% represented Grade III-complications, such as urine leakage, haematoma, colonic lesion, and stone formation. Recurrent UPJ-stenosis requiring reintervention was seen in 3.5-4.8%. In all three large series, complications were part of the learning curve.

Laparoscopic pyeloplasty has been proven safe and effective with comparable results to open surgery. The experience of pioneering centres with incidence and management of complications will be used by next generations of laparoscopic urologic surgeons to shorten their learning curve.