title: Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification.
abstract: BACKGROUND
  Laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN.
  
  
  METHODS
  We analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system.
  
  
  RESULTS
  The mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥ 8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥ 7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively).
  
  
  CONCLUSIONS
  The overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.
authors.forename: Chia-Min
authors.initials: CM
authors.lastname: Yang
authors.forename: Hsiao-Jen
authors.initials: HJ
authors.lastname: Chung
authors.forename: Yi-Hsiu
authors.initials: YH
authors.lastname: Huang
authors.forename: Tzu-Pin
authors.initials: TP
authors.lastname: Lin
authors.forename: Alex T L
authors.initials: AT
authors.lastname: Lin
authors.forename: Kuang-Kuo
authors.initials: KK
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000145:classification*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*