TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Postoperative bleeding is a known risk of any surgery. Although this risk is recognized, there is limited characterization of the rate of this occurrence in laparoscopic and robotic surgery. This study assessed the risk and presentation of post-operative take-back after minimally invasive urologic surgery.
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Methods: All complications following adult laparoscopic or robotic urologic surgeries performed by three experienced Urologists at a single institution were retrospectively reviewed over a four year time period (2008–2012).
Results: A total of 2380 laparoscopic/robotic surgeries were performed during this time period. There were 5 cases (0.21%, 4 laparoscopic, 1 robotic) in which the patient required re-operation for postoperative bleeding. The laparoscopic cases were a retroperitoneal lymph node dissection, partial nephrectomy, radical nephrectomy and nephroureterectomy. The robotic case was a radical prostatectomy. Summary of initial patient characteristics and original surgery are in Table 1. While estimated blood loss varied, none of the patients required transfusion during original surgery. All reoperations occurred within the first 24 hours postoperatively and indications for reoperation included hemodynamic instability in all cases. A summary of resuscitative measures and take-back findings is within Table 2.
Conclusions: Bleeding requiring re-operation is a recognized rare complication of minimally invasive surgery, even in experienced hands. Hemodynamic instability and significant acute blood loss anemia are universally seen in these patients and drive return to the operating room.
Source of Funding: None
|Listen to an interview with Jessica Kreshover, one of the authors of this study.|
Presented by Jessica Kreshover, Lee Richstone, and Louis Kavoussi at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
Arthur Smith Institute of Urology, Hyde Park, NY USA