Complications of laparoscopic nephrectomy – determining risk factors for complications and conversion to open surgery after an experience of 402 cases

52 Complications of laparoscopic nephrectomy – determining risk factors for complications and conversion to open surgery after an experience of 402 cases Botea M., Chira I., Ambert V., Badescu D., Dragomiristeanu I., Diaconescu D., Radu T., Salahhedin Y., Petca R., Pisoschi M., Gutue S., Nedelea S., Jinga V. Prof Dr Th Burghele Clinical Hospital, Dept. of Urology, Bucharest, Romania INTRODUCTION & OBJECTIVES: To assess the incidence of intraoperative and short-term postoperative complications associated with laparoscopic nephrectomy performed for various indications. We also attempt to define risk factors for complications and conversion to open surgery during this procedure. MATERIAL & METHODS: We retrospectively analyzed our institution initial 402 patients undergoing laparoscopic nephrectomy from May 2010 to June 2015. We reviewed the data base of patients in order to identify risk factors related to complications and conversion to an open surgical procedure. All 402 laparoscopic nephrectomies were performed by a total of 7 surgeons. RESULTS: Indications for nephrectomy included benign renal pathology in 125 (31,09%) patients: 117 (29,1%) cases of hydronephrosis, 7 (1,75%) cases of renal dysplasia, 1 (0,25%) hydatid cyst; 203 (50,49%) patients required laparoscopic radical nephrectomy for renal cell carcinoma and 74 (18,4%) nephroureterectomy for upper tract transitional cell carcinoma. The overall complication rate was 14,67%. There was no mortality. Intraoperative complications were noted in 43 (10,69%) patients: 27 (6,71%) cases of vascular injury, 8 (1,99%) cases of failure to progress, 1 bowel injury and 1 case of hypercarbia. The conversion rate was 6,96%: 12 emergency and 16 elective conversions. 9 cases requiring elective conversion were in patients with underlying inflammatory conditions or previous surgery. Postoperative complications: 4 cases of hemoperitoneum, 4 cases of musculoskeletal injuries, 1 case of peritonitis. The reintervention rate was 1,49% due to bleeding in 4 cases, 1 abscess formation and 1 peritonitis. The transfusion rate was 8,70%. Mean hospital stay was 5,6 days. The mean operative duration was 158 min including the learning curves of 7 surgeons. The mean surgical time was 225 min for the first 100 cases and decreased to 210 min for the following 150 cases and 151 min for the last 100 cases. Also incidence of complications and conversions decreased with experience: a complication rate of 22% and conversion rate of 15 % during the initial 100 cases vs 12% respectively 8% for the last 100 cases. CONCLUSIONS: Laparoscopic nephrectomy can be undertaken for a variety of indications with reasonable complication and conversion rates. Our results support the importance of careful patient selection and surgeon experience in laparoscopy. For patients with severe perinephritis a higher likelihood of open conversion must be considered.Surgeon experience, length of the procedure, inflammatory conditions or previous surgery may be considered to be key points in preventing complications. Eur Urol Suppl 2015; 14(6): e1220