Routine postoperative chest x-ray following laparoscopic nephrectomy.
OBJECTIVE
To determine whether a routine postoperative chest x-ray is required following uneventful laparoscopic nephrectomy to rule out pneumothorax.


METHODS
From June 1999 to May 2003, 308 laparoscopic nephrectomy cases were performed by 5 different surgeons. This consisted of 121 radical nephrectomies, 106 donor nephrectomies, 29 simple nephrectomies, 29 partial nephrectomies, and 23 nephroureterectomies. Of the 308 procedures, 186 postoperative chest x-ray s were obtained in the recovery room: 183 routinely and 3 for known intraoperative diaphragmatic injuries. Routine chest x-rays were not obtained in 122 cases due to the individual surgeon's preference. Of these 122 patients, 15 underwent chest x-ray performed while hospitalized secondary to pulmonary issues or fever.


RESULTS
Of the 308 cases, 4 pneumothoraces were identified on chest x-ray. Three were identified in the patients who had intraoperative identification of diaphragmatic injury. The fourth pneumothorax was identified in a patient who did not have a routine postoperative chest x-ray but did have a chest x-ray obtained due to postoperative shoulder pain. The pneumothorax in this patient resolved spontaneously. No incidental findings existed of pneumothorax in any patient who underwent routine postoperative chest x-ray.


CONCLUSIONS
In our series, a pneumothorax was identified either intraoperatively or based on postoperative clinical findings. None of the 183 routine postoperative chest x-rays changed patient management. Routine postoperative chest x-ray is not necessary in uncomplicated laparoscopic nephrectomy.
Simon
Scott D
SD
Laparoendoscopic and Reconstructive Surgery, Mayo Clinic, Scottsdale, Arizona 85255, USA.
Castle
Erik P
EP
Ferrigni
Robert G
RG
Andrews
Paul E
PE
D003955:Diagnostic Tests, Routine; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009392:Nephrectomy / Q000009:adverse effects*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D011182:Postoperative Care; D013902:Radiography, Thoracic