ENDOUROLOGY & LAPAROSCOPY

Decreased Complications of Contemporary Laparoscopic Partial Nephrectomy: Use of a Standardized Reporting System
Simmons MN, Gill IS
Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
J Urol. 2007; 177: 2067-73

• Purpose: We report complications of laparoscopic partial nephrectomy in a contemporary cohort of 200 patients using a standardized complication reporting system.
• Materials and Methods: The records of 200 consecutive patients undergoing laparoscopic partial nephrectomy between September 2003 and November 2005 were reviewed. Mean tumor size was 3 cm and mean parenchymal invasion depth was 1.8 cm. There were 97 central tumors (48.5%) and 9 tumors (4.5%) in a solitary kidney. Complication severity for each patient was graded using a 5-tiered scale based on National Cancer Institute Common Toxicity Criteria. Statistical analysis was done to assess risk factors associated with complication events.
• Results: A total of 35 patients (17.5%) had complications. The overall complication rate was 19%. Of the complications 29%, 42%, 26% and 2.6% were grades I to IV, respectively. There were no grade V complications. Median blood loss was 150 ml. Hemorrhagic and urine leak complications occurred in 9 (4.5%) and 4 patients (2%), respectively. Conversion to open partial and laparoscopic radical nephrectomy was done electively in 2 (1%) and 1 patients (0.5%), respectively. Compared to previously reported data on the initial 200 patients in our laparoscopic partial nephrectomy cohort this contemporary group of 200 had statistically significant decreases in overall, urological and hemorrhagic complication rates despite an increase in tumor complexity (p = 0.02, 0.04 and 0.04, respectively).
• Conclusions: Increased experience with advanced laparoscopic techniques has allowed a significantly decreased complication rate following contemporary laparoscopic partial nephrectomy, which now appears comparable to that of open partial nephrectomy. A standardized complication reporting system is advocated.
  
  
• Editorial Comment
  Laparoscopy partial nephrectomy has been challenged and questioned as treatment of renal tumors < 4 cm. The authors demonstrated an improvement in their complications rates due to the vast number of procedures and their learning curve. The authors used the NCI-CTC reporting system for surgical complications, which apparently standardizes definitions of complication events and enables clear comparison of the frequency and severity of events among various series. In conclusion, although the learning curve may be steep for certain laparoscopic procedures, this minimally invasive approach seems to mimic and is comparable to the open counterpart.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
E-mail: fernando.kim@uchsc.edu