ENDOUROLOGY & LAPAROSCOPY

Meta-Analysis of the Complications of Laparoscopic Renal Surgery: Comparison of Procedures and Techniques
Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY
Division of Urology, Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin, USA
J Urol. 2006; 175: 1208-13

• Purpose: We performed a meta-analysis of the literature to define the current expectations of complications during laparoscopic renal surgery.
• Materials and Methods: References were searched in the MEDLINE database from 1995 to 2004 using the terms complications and laparoscopic nephrectomy. Inclusion criteria were any series with greater than 20 cases, patient age older than 16 years and any complications listed for certain procedures, including laparoscopic radical nephrectomy, HA laparoscopic radical nephrectomy, LPN, HALPN, laparoscopic donor nephrectomy, HA laparoscopic donor nephrectomy, laparoscopic simple nephrectomy, laparoscopic nephroureterectomy and retroperitoneal laparoscopic nephrectomy. A data extraction form was created to categorize major or minor complications. A 5 member panel adhered to the strict criteria and extracted data from articles that met inclusion criteria. Data were entered into a spreadsheet and a meta-analysis was performed.
• Results: Initial review identified 73 of 405 references that were acceptable for retrieval and data extraction, of which 56 met inclusion criteria. The overall major and minor complication rates of laparoscopic renal surgery were 9.5% and 1.9%, respectively. There was a significant difference between the major complication rates of LPN and HALPN (21.0% vs 3.3%, p < 0.05).
• Conclusions: Our results show that patients who undergo laparoscopic renal surgery may have an overall major complication rate of 9.5%. The highest major complication rate is associated with technically challenging LPN (21%). There appears to be a significantly higher wound complication rate associated with HA surgery in comparison to that of standard laparoscopy (1.9% vs 0.2%, p < 0.05).
  
  
• Editorial Comment
  Since the first laparoscopic nephrectomy was performed and documented by Clayman and colleagues, the array of procedures using the laparoscopic approach has evolved. The development of new laparoscopic instruments and technology allowed laparoscopic surgeons to apply the same surgical principles as in open surgery. The authors demonstrated that laparoscopic renal surgery is safe and reproducible. Moreover, laparoscopic partial nephrectomy remains a complex procedure including ablative and reconstructive steps but the aid of hand assist devices may decrease the rate of complications for this particular procedure. Conversely, the hand assisted surgeries compared to pure laparoscopic procedures had higher incidence of wound related complications. In conclusion, the laparoscopic approach for kidney surgery should be considered a “winner” in terms of surgical technique allowing patients to benefit from it for over a decade and half.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA