Complications of upper urinary system laparoscopic surgery: a single center experience with 942 cases

Year 2021, Volume: 7 Issue: 4, 363 - 367, 04.07.2021

Mithat Ekşi , Selçuk Şahin , Nevzat Şener , Kamil Gökhan Şeker , İsmail Evren , Serdar Karadağ , Abdullah Hızır Yavuzsan , Deniz Noyan Özlü , Volkan Tuğcu

https://doi.org/10.18621/eurj.780801

Cited By: 1

Abstract

Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system.

Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately.

Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329).

Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.

Keywords

Laparoscopy, urology, intraoperative complications, postoperative complications

References

• 1. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278-82.
• 2. Gonzalgo ML, Pavlovich CP, Trock BJ, Link RE, Sullivan W, Su LM. Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy. J Urol 2005;174:135-9.
• 3. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
• 4. Guillonneau B, Abbou CC, Doublet JD, Gaston R, Janetschek G, Mandressi A, et al. Proposal for a “European scoring system for laparoscopic operations in urology.” Eur Urol 2001;40:2-7.
• 5. Parra RO, Hagood PG, Boullier JA, Cummings JM, Mehan DJ, Griffith DP. Complications of laparoscopic urological surgery: Experience at St. Louis University. J Urol 1994;151:681-4.
• 6. Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 German centers. J Urol 1999;162:765-77
• 7. Cadeddu JA, Wolfe JS Jr, Nakada S, Chen R, Shalhav A, Bishoff JT, et al. Complications of laparoscopic procedures after concentrated training in urological laparoscopy. J Urol 2001;166:2109-11.
• 8. Soulié M, Salomon L, Seguin P, Mervant C, Mouly P, Hoznek A, et al. Multi-institutional study of complications in 1085 laparoscopic urologic procedures. Urology 2001;58:899-3.
• 9. Vallancien G, Cathelineau X, Baumert H, Doublet JD, Guillonneau B. Complications of transperitoneal laparoscopic surgery in urology: review of 1,311 procedures at a single center. J Urol 2002;168:23-6.
• 10. Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol 2007;177:580-5.
• 11. Inoue T, Kinoshita H, Satou M, Oguchi N, Kawa G, Muguruma K, et al. Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures. J Endourol 2010;24:253-60.
• 12. Colombo JR Jr, Haber GP, Jelovsek JE, Nguyen M, Fergany A, Desai MM, et al. Complications of laparoscopic surgery for urological cancer: a single institution analysis. J Urol 2007;178:786-91.
• 13. Akin Y, Ates M, Celik O, Ucar M, Yucel S, Erdogru T. Complications of urologic laparoscopic surgery: a center surgeon’s experience involving 601 procedures including the learning curve. Kaohsiung J Med Sci 2013;29:275-9.
• 14. Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996;77:217-22.
• 15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
• 16. Sanli O, Tefik T, Erdem S, Ortac M, Salabas E, Karakus S, et al. Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: experience of 1023 cases including learning curve in 9 years. J Minim Access Surg 2016;12:33-40.
• 17. Rassweiler JJ, Seemann O, Frede T, Henkel TO, Alken P. Retroperitoneoscopy: experience with 200 cases. J Urol 1998;160:1265-9.
• 18. Gill IS, Clayman RV, Albala DM, Aso Y, Chiu AW, Das S, et al. Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective. Urology 1998;52:566-71.