Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures.
OBJECTIVE
We evaluated complications of urologic laparoscopic surgery at our institution.


METHODS
From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively.


RESULTS
Among the 1017 laparoscopic procedures, 148 complications occurred in 123 patients, resulting in a total complication rate of 14.6%. Conversion to open surgery occurred in 20 (1.9%) patients. Nephrouretectomy had the highest incidence of complications at 23.7%, which was significantly higher than that of other procedures classified as "difficult" group, according to the ESS (P < 0.05). Clavien grades I and II accounted for 73.8% of all the postoperative complications. We experienced one fatality that was caused by air embolism.


CONCLUSIONS
We evaluated the complications of each procedure using the ESS for classification of technical difficulty. Based on the results of our retrospective study, nephrouretectomy should be upgraded as "very difficult" group according to the ESS. Appropriate grading by technical difficulty is beneficial for the prevention of complications from laparoscopic surgery.
Inoue
Takaaki
T
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
Takaaki
Inoue
I
Kinoshita
Hidefumi
H
Satou
Masahiko
M
Oguchi
Naoki
N
Kawa
Gen
G
Muguruma
Kouei
K
Murota
Takayuki
T
Matsuda
Tadashi
T
D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*