title: Laparoendoscopic single-site upper urinary tract surgery: assessment of postoperative complications and analysis of risk factors.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to minimise the morbidity and scarring associated with surgical intervention.
  
  
  OBJECTIVE
  To evaluate the incidence of and the risk factors for complications in patients undergoing LESS upper urinary tract surgery.
  
  
  METHODS
  Between September 2007 and February 2011, 192 consecutive patients underwent LESS for upper urinary tract diseases at four institutions.
  
  
  METHODS
  All complications occurring at any time after surgery were captured, including the inpatient stay as well as in the outpatient setting. They were classified as early (onset<30 d), intermediate (onset 31-90 d), or late (onset>90 d) complications, depending on the date of onset. All complications were graded according to the modified Clavien classification.
  
  
  CONCLUSIONS
  The patient population was generally young (mean: 55±18 yr of age), nonobese (mean body mass index [BMI]: 26.5±4.8 kg/m2), and healthy (mean preoperative American Society of Anaesthesiologists [ASA] score: 2±1). Forty-six patients had had prior abdominal surgery. Mean operative time was 164±63 min, with a mean estimated blood loss (EBL) of 147±221 ml. In 77 cases (40%), the surgeons required additional ports, with a standard laparoscopy conversion rate of 6%. Mean hospital stay was 3.3±2.3 d, and the mean visual analogue scale (VAS) score at discharge was 1.7±1.43. Thirty-three complications were recorded-30 early, 2 intermediate, and 1 late-for an overall complication rate of 17%. Statistically significant associations were noted between the occurrence of a complication and age, ASA score, EBL, length of stay (LOS), and malignant disease at pathology. Univariable and the multivariable analyses showed that a higher ASA score (incidence rate ratio [IRR]: 1.4; 95% confidence interval [CI], 1.0-2.1; p=0.034) and malignant disease at pathology (IRR: 2.5; 95% CI, 1.3-4.7; p=0.039) represented risk factors for complications. Poisson regression analysis over time showed a 23% non-statistically significant reduction in risk of complications every year (IRR: 0.77; 95% CI, 0.5-1.19; p=0.242).
  
  
  CONCLUSIONS
  Malignant disease at pathology and high ASA score represent a predictive factor for complication after LESS for upper urinary tract surgery. Thus, surgeons approaching LESS should start with benign diseases in low-surgical-risk patients to minimise the likelihood of postoperative complications.
authors.affiliation: Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany. francesco.greco@medizin.uni-halle.de
authors.forename: Francesco
authors.initials: F
authors.lastname: Greco
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stein
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Caterina
authors.initials: C
authors.lastname: Fanizza
authors.forename: Luigi
authors.initials: L
authors.lastname: Schips
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D016896:Treatment Outcome; D014551:Urinary Tract / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods