Laparoscopic Exploration for the Detection and Treatment of Early Complications from Laparoscopic Urologic Surgery
Matthew Wszolek, MD, Alireza Moinzadeh, MD, Ingolf Tuerk, MD, Andrea Sorcini, MD.
Lahey Clinic, Burlington, MA, USA.
Background: Traditionally laparotomy is the most common approach for early abdominal complications following minimally invasive surgery. After initial experience with complications from laparoscopic procedures, we established a policy of laparoscopic exploration as the first line intervention for patients with proven or suspected intra-abdominal complications within 21 days of their initial surgery.
Methods: From October 2003 to September 2008, 1962 laparoscopic or robotic surgeries were performed at our institution. Every patient with a documented or suspected intra-abdominal complication within 21 days of their initial procedure was explored laparoscopically if pneumoperitoneum could be safely established. Data regarding the nature of the complication, and the preoperative diagnostic studies utilized were recorded as well as intra-operative data from the exploration including need for additional trocars, estimated blood loss and operative time. Post-exploration length of hospital stay, complications and need for further treatment were also recorded.
Results: 14 patients required exploratory surgery within 21 days of their initial procedure. Initial surgeries including laparoscopic or robotic prostatectomy in 6 cases, laparoscopic nephrectomy in 4 cases, laparoscopic pelvic lymph node dissection in 2 cases, laparoscopic partial nephrectomy in 1 case, and laparoscopic pyeloplasty in 1 case . Indications for exploration included suspected or proven bowel injury (5), bleeding (3), symptomatic lymphocele (3), anastomotic disruption (2), and ureteral injury (1). In 2 cases of bowel injury exploratory laparoscopy was not attempted due to marked abdominal distension. In the 12 patients explored laparoscopically, estimated blood loss was not >100ml in a single case, mean operative time was 107 minutes, and no additional trocars were required. The mean length of stay was 2.1 days after laparoscopic exploration. Two complications were reported. One patient developed a wound infection and one patient developed a recurrent UPJ obstruction requiring endopyelotomy.
Conclusion: Laparoscopic exploration for acute intra-abdominal complications from minimally invasive surgery can be safely and successfully performed in the majority of cases. The advantages of the minimally invasive approach appear to be maintained in this setting.