González-León T, Ochoa-Gibert Y, Rodríguez-Prieto M, Rodríguez-Gómez Y

Language: English
References: 26
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ABSTRACT

Introduction: Surgery by lumboscopic approach is of choice for some work groups, despite being more arduous and requiring a higher learning curve.
Objective: To assess the lumboscopic approach and identify predictive factors of complications and conversion to open surgery.
Material and Methods: A transversal, retrospective study of 436 patients that underwent surgery by lumboscopy at the National Center for Minimally Invasive Surgery, 2008-2019. Absolute and relative frequencies; the Chi-Square Test and Student´s t Test and the Multiple Logistics Regression, were utilized, (p≤0.05).
Results: Renal atrophy due to benign diseases (49.8%), renoureteral lithiasis (26.6%), surgery of moderate complexity (71.9%) prevailed, such as nephrectomy (50.2%). 16.1% had undergone prior surgery, and 12.4% a urinary derivation. 3% required conversion to open surgery and 18.8% presented complications. Renal staghorn and non-staghorn lithiasis, surgical technique, level of complexity of the surgery, operative time, transoperative bleeding and length of hospital stay were significantly associated (p‹0.05) to complications, but after measuring logistics regression, only hospital stay resulted statistically significant (p=0.000). Regarding conversion: gender, past history of prior surgery, operative time and bleeding were significantly associated (p‹0.05) in both the univariate and multivariate analysis.
Conclusions: Nephrectomy due to benign causes and surgeries of moderate complexity prevailed in this series. The perioperative outcomes were satisfactory and the most frequent complications were postoperative, infectious and of grade II severity. Longer hospital stay was a predictive factor for complications whereas males, past history of prior surgery, longer operative time and bleeding were identified as predictive factors for conversion to open surgery.

REFERENCES

1. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device. J Urol. 1992;148(4):1137–9. doi: 10.1016/s0022- 5347(17)36842-8

2. Saifee Y, Nagarajan R, Qadri SJ, Sarmah A, Kumar S, Pal BC, et al. Retroperitoneoscopic nephrectomy for benign nonfunctioning kidneys: Training and outcome. Indian J Urol. 2016;32(4):301–5. doi: 10.4103/0970- 1591.189724

3. Srivastava A, Sureka SK, Vashishtha S, Agarwal S, Ansari MS, Kumar M. Single-centre experience of retroperitoneoscopic approach in urology with tips to overcome the steep learning curve. J Minim Access Surg. 2016;12(2):102–8. doi: 10.4103/0972-9941.178517

4. Rassweiler JJ, Seemann O, Frede T, Henkel TO, Alken P. Retroperitoneoscopy: experience with 200 cases. J Urol. 1998;160(4):1265–9. doi: 10.1016/s0022-5347(01)62512-6

5. González León T. Laparascopic nephrectomy: different techniques and approaches. Curr Urol Rep. 2015;16(2):7. doi: 10.1007/s11934-014- 0476-4

6. Rassweiler J, Klein J, Goezen AS. Retroperitoneal laparoscopic non-dismembered pyeloplasty for uretero-pelvic junction obstruction due to crossing vessels: A matchedpaired analysis and review of literature. Asian J Urol. 2018;5(3):172–81. doi: 10.1016/j. ajur.2018.03.001

7. Klap J, Butow Z, Champy CM, Masson-Lecomte A, Defontaines J, De la Taille A, et al. 1,000 Retroperitoneoscopic Procedures of the Upper Urinary Tract: Analysis of Complications. UIN. 2019;102(4):406–12. doi: 10.1159/000497038

8. Lombardo R, Martos R, Ribal MJ, Alcaraz A, Tubaro A, De Nunzio C. Retroperitoneoscopy in urology: a systematic review. Minerva Urol Nefrol. 2019;71(1):9–16. doi: 10.23736/S0393- 2249.18.03235-6

9. Danilovic A, Ferreira TAC, Maia GV de A, Torricelli FCM, Mazzucchi E, Nahas WC, et al. Predictors of surgical complications of nephrectomy for urolithiasis. Int braz j urol. 2019;45:100–7. doi: 10.1590/S1677-5538. IBJU.2018.0246

10. González León T, Ortega Vega E, Morera Pérez M, Sánchez Tamaki R, Quintana Rodríguez M. Complicaciones en la nefrectomía mediante abordaje lumboscópico. Revista Cubana de Urología. 2020;9(1):13–23.

11. Aminsharifi A, Goshtasbi B. Laparoscopic Simple Nephrectomy After Previous Ipsilateral Open Versus Percutaneous Renal Surgery. JSLS. 2012;16(4):592–6. doi: 10.4293/108680812X1 3462882737212

12. Gahlawat S, Sood R, Sharma U, Khattar N, Akhtar A, Pandey PK, et al. Can preoperative clinicoradiological parameters predict the difficulty during laparoscopic retroperitoneal simple nephrectomy? – A prospective study. Urol Ann. 2018;10(2):191–7. doi: 10.4103/ UA.UA_141_17

13. Naghiyev R, Imamverdiyev S, Efendiyev E, Şanlı Ö. Laparoscopic transperitoneal and retroperitoneal simple nephrectomy: The impact of etiological factors of the results of surgical treatment. Turk J Urol. 2017;43(3):319–24. doi: 10.5152/tud.2017.21855

14. González León T, Machado Álvarez M, Rodríguez Verde E, Suárez Marcillán ME, Bautista Olivé J. Empleo de la cirugía lumboscópica en pacientes atendidos en el Centro Nacional de Cirugía de Mínimo Acceso. Revista Cubana de Medicina Militar. 2012;41(2):151–9.

15. Liapis D, de la Taille A, Ploussard G, Robert G, Bastien L, Hoznek A, et al. Analysis of complications from 600 retroperitoneoscopic procedures of the upper urinary tract during the last 10 years. World J Urol. 2008;26(6):523. doi: 10.1007/s00345-008-0319-3

16. Jain S, Jain SK, Kaza RCM, Singh Y. This challenging procedure has successful outcomes: Laparoscopic nephrectomy in inflammatory renal diseases. Urol Ann. 2018;10(1):35–40. doi: 10.4103/UA.UA_9_17

17. Gill IS, Clayman RV, Albala DM, Aso Y, Chiu AW, Das S, et al. Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective. Urology. 1998;52(4):566–71. doi: 10.1016/s0090-4295(98)00314-8

18. Al-Otaibi K. Complications of 411 laparoscopic urological procedures: A single surgeon experience. Urol Ann. 2018;10(3):308–12. doi: 10.4103/UA.UA_190_17

19. Zelhof B, McIntyre IG, Fowler SM, Napier- Hemy RD, Burke DM, Grey BR, et al. Nephrectomy for benign disease in the UK: results from the British Association of Urological Surgeons nephrectomy database. BJU Int. 2016;117(1):138–44. doi: 10.1111/bju.13141

20. Sanli O, Tefik T, Erdem S, Ortac M, Salabas E, Karakus S, et al. Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years. J Minim Access Surg. 2016;12(1):33–40. doi: 10.4103/0972- 9941.158154

21. Angerri O, López JM, Sánchez-Martin F, Millán-Rodriguez F, Rosales A, Villavicencio H. Simple Laparoscopic Nephrectomy in Stone Disease: Not Always Simple. Journal of Endourology. 2016;30(10):1095–8. doi: 10.1089/end.2016.0281

22. Tepeler A, Akman T, Tok A, Kaba M, Binbay M, Müslümanoğlu AY, et al. Retroperitoneoscopic nephrectomy for non-functioning kidneys related to renal stone disease. Urol Res. 2012;40(5):559–65. doi: 10.1007/s00240-012- 0466-2

23. Fahlenkamp D, Rassweiler J, Fornara P, Frede T, Loening SA. Complications of laparoscopic procedures in urology: experience with 2,407 procedures at 4 german centers. Journal of Urology. 1999;162(3 Part 1):765–71. doi: 10.1097/00005392-199909010-00038

24. Hsu RCJ, Salika T, Maw J, Lyratzopoulos G, Gnanapragasam VJ, Armitage JN. Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type. BMJ Open. 2017;7(9):e016833. doi: 10.1136/ bmjopen-2017-016833

25. Cadeddu JA, Wolfe JS, Nakada S, Chen R, Shalhav A, Bishoff JT, et al. Complications of laparoscopic procedures after concentrated training in urological laparoscopy. Journal of Urology. 2001 Dec 1;166(6):2109–11. doi: 10.1016/S0022-5347(05)65515-2

26. Fuat Demirel, Fatih Yalçınkaya, Murat Çakan. Assessment of Technical Difficulty and Complications of Urological Laparoscopic Operations According to “European Scoring System”&58; 228 Cases. Journal of Urological Surgery. 2015 Jan 1;2(2):69–74. doi: 10.4274/ jus.2015.271