Laparoendoscopic Single-Site Upper Urinary Tract Surgery: Assessment of Postoperative Complications and Analysis of Risk Factors

• Published in: European urology 2012-03, Vol.61 (3), p.510-516
• Main Authors: Greco, Francesco, Cindolo, Luca, Autorino, Riccardo, Micali, Salvatore, Stein, Robert J, Bianchi, Giampaolo, Fanizza, Caterina, Schips, Luigi, Fornara, Paolo, Kaouk, Jihad
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Loss, Surgical - statistics & numerical data; Body Mass Index; Complications; Female; Humans; Incidence; Laparoendoscopic single-site surgery; Laparoscopy - adverse effects; Laparoscopy - instrumentation; Laparoscopy - methods; Length of Stay; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Outcomes; Postoperative Complications - epidemiology; Risk Factors; Standardised criteria; Treatment Outcome; Upper urinary tract; Urinary Tract - surgery; Urologic Surgical Procedures - adverse effects; Urologic Surgical Procedures - methods; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2011.08.032

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. Design, setting, and participants Between September 2007 and February 2011, 192 consecutive patients underwent LESS for upper urinary tract diseases at four institutions. Measurements 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 90 d) complications, depending on the date of onset. All complications were graded according to the modified Clavien classification. Results and limitations 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 comp