Complications

At our center, vascular injuries were identified in 1.7% (7 of 404) and bowel injuries in 0.25% (1 of 404) of the patients undergoing major retroperitoneal laparoscopic renal and adrenal surgery between July 1997 and February 2001 (17). In five patients (63%), the injury could be controlled laparoscopically. Two patients required postoperative intensive care for one and three days, respectively. Of seven patients with vascular injuries, five required an average of 3.3 units of packed cells (range 1-8). Postoperatively ileus and atelectasis occurred in one patient and transient hypotension in another.

In an earlier multi-institutional review of 1043 retroperitoneoscopic/extraperito-neoscopic cases, Gill et al. (3) found that major complications occurred in 49 (4.7%) patients. Visceral injuries occurred in 26 (2.5%) patients and vascular injuries in 23 (2.2%). The commonest visceral injuries were pneumothorax (n = 6), pneumomediastinum (n = 4), and perforation of the urinary bladder (n = 4). Of note, of the 26 visceral injuries (2.5%), 7 (0.7%) were sustained by intraperitoneal organs: colon (n = 3), small bowel (n = 2), liver (n = 1), and spleen (n = 1). Of the vascular injuries (2.2%), the renal vein (n = 6) and inferior vena cava (n = 4) were the most frequently injured blood vessels. The retroperitoneoscopic/extraperitoneoscopic procedure was intraoperatively converted to transperitoneal laparoscopy in 56 (5.4%) patients. Conversion to open surgery was necessary in 69 patients (6.6%). Conversion to open surgery was performed in an elective manner in 41 patients (3.9%) and emergently in 28 patients (2.7%). Elective conversion to open surgery was most commonly indicated for significant adhesions or peritoneal tear (n = 15; 1.4%) or inadequate working space in the retroperitoneum (n = 13; 1.3%). Emergent open surgery was necessary to repair either visceral (n = 16; 1.5%) or vascular (n = 12; 1.2%) injuries.

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