Complications of Laparoscopic Nephrectomy in 185 Patients: A Multi-Institutional Review

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Abstract
We document the incidence of complications associated with laparoscopic nephrectomy in a multi-institutional study. The study included the initial 185 patients undergoing laparoscopic nephrectomy at 5 centers in the United States between June 1990 and July 1993. A total of 30 patients (16 percent) had 34 complications. There was no mortality. Access-related complications included 2 cases of hernia formation at the trocar site, 1 abdominal wall hematoma and 1 trocar injury to a hydronephrotic kidney. Intraoperative complications included 5 cases of vascular injury, 1 splenic laceration and 1 pneumothorax. Postoperative complications involved the gastrointestinal tract in 6 cases, cardiovascular system in 6, genitourinary tract in 4, respiratory system in 4 and musculoskeletal system in 2. Miscellaneous complications occurred in 3 patients. Open surgical intervention was required electively in 8 patients and on an emergency basis in 2. The incidence of complications decreased with experience: 71 percent occurred during the initial 20 cases at each institution. In our early experience the complication rate for laparoscopic nephrectomy was 12 percent in patients with benign renal disease and 34 percent in those with renal cancer. Based on this collective experience, recommendations for prevention, recognition and treatment of complications are made.