The most common complication was a vascular injury (2%), followed by postoperative blood transfusion (1.8%), ileus prolonging hospital stay beyond 48 hours (1.6%), and wound infection (1.1%). The conversion rate to open was 2.7%. Overall, almost 80% of complications were noted postoperatively; among these, 28% were of a major nature.

Of great value in this paper is the careful analysis of complications for each laparoscopic procedure performed. In this regard, it is of note that the greatest percent of complications was seen with laparoscopic nephroureterectomy (33%) with a three way tie for second place at 23% (laparoscopic partial nephrectomy, laparoscopic donor nephrectomy, and adrenalectomy). The highest incidence of laparoscopic vascular injuries occurred with laparoscopic donor nephrectomy (2.4%). Of note, the institutional "learning curve" appeared to occur over a 7 year period; after 2000 the complication rate remained stable. Lastly, the primary risk factor for complications in this series was an increased ASA score (32% vs. 19% for ASA 1 or 2).

Permpongkosol S, Link RE, Su LM, Romero FR, Bagga HS, Pavlovich CP, Jarrett TW, Kavoussi LR

J. Urol. 177(2): 580-585, February 2007

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Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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