Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
J Endourol. 2010 Feb;24(2):253-60. doi: 10.1089/end.2009.0322.
We evaluated complications of urologic laparoscopic surgery at our institution.
From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively.
Among the 1017 laparoscopic procedures, 148 complications occurred in 123 patients, resulting in a total complication rate of 14.6%. Conversion to open surgery occurred in 20 (1.9%) patients. Nephrouretectomy had the highest incidence of complications at 23.7%, which was significantly higher than that of other procedures classified as "difficult" group, according to the ESS (P < 0.05). Clavien grades I and II accounted for 73.8% of all the postoperative complications. We experienced one fatality that was caused by air embolism.
We evaluated the complications of each procedure using the ESS for classification of technical difficulty. Based on the results of our retrospective study, nephrouretectomy should be upgraded as "very difficult" group according to the ESS. Appropriate grading by technical difficulty is beneficial for the prevention of complications from laparoscopic surgery.
我们评估了本机构泌尿科腹腔镜手术的并发症。
1991 年 12 月至 2009 年 1 月，在关西医科大学进行了 1017 例泌尿科腹腔镜手术，包括 277 例根治性前列腺切除术、13 例供肾切除术、74 例部分肾切除术、158 例根治性肾切除术、55 例肾盂成形术、97 例肾输尿管切除术、54 例单纯肾切除术、128 例肾上腺切除术、34 例精索静脉结扎术和 127 例其他手术。回顾性评估了每例手术的病历。根据欧洲评分系统（ESS）对每例手术的难度进行分类。根据 Satava 和 Clavien 分类分别对术中及术后并发症进行分级。
在 1017 例腹腔镜手术中，123 例患者共发生 148 例并发症，总并发症发生率为 14.6%。20 例（1.9%）患者转为开放手术。肾输尿管切除术的并发症发生率最高（23.7%），明显高于 ESS 分类为“困难”组的其他手术（P < 0.05）。Clavien 分级 I 级和 II 级占所有术后并发症的 73.8%。我们有 1 例死亡病例，是由空气栓塞引起的。
我们使用 ESS 对技术难度进行分类，评估了每种手术的并发症。基于我们的回顾性研究结果，根据 ESS，肾输尿管切除术应升级为“非常困难”组。根据技术难度进行适当分级有助于预防腹腔镜手术的并发症。
