Complications in pediatric urological laparoscopy: results of a survey

To assess the level of activity in pediatric urological laparoscopy and its relationship to complications a survey of the membership of the American Academy of Pediatrics, Section on Urology was conducted.

An anonymous questionnaire was mailed to 251 pediatric urologists and 153 responses were recorded.

Of the respondents 75% reported performing diagnostic and operative laparoscopy (average 54 cases). Patient age ranged from newborn to 20 years. Average case load for laparoscopy was 19 of 401 total cases yearly. More than 5,400 laparoscopic cases are represented by the reported experience. Complications were reported in 5.38% of cases (average complication rate 6.06% per practitioner). Excluding preperitoneal insufflation or subcutaneous emphysema the complication rate was 1.18%. Complications requiring surgical repair occurred in 0.39% of cases, including bowel, bladder and great vessel injury. The clearest predictor of complication rate was laparoscopic experience. The technique used to obtain pneumoperitoneum was also important in that Veress needle technique was associated with a 2.6% significant complication rate in contrast to 1.2% for open technique (p < 0.006).

Laparoscopy is widely practiced in the pediatric urological community with a good safety record. Complications occur and important means of minimizing them are to provide for supervised experience with emphasis on the details of safe technique.