Complications of laparoscopic procedures in urology: Experience with 2,407procedures at 4 German centers

Purpose: The 4 most active centers of the laparoscopy working group of the German Urologic Association collected data about the complications associat ed with laparoscopic surgery in urology. Materials and Methods: At 4 centers 2,407 laparoscopies or retroperitoneosc opies were performed as of May 1998, including 776 for varicocelectomy, 259 for cryptorchidism, 481 for pelvic lymph no de dis section, 351 for nephre ctomy/heminephrectomy renal pathology, 139 for renal cyst resection, 58 for ureteral procedures, 44 for adrenalectomy, 41 for nephropexy, 41 for lymph ocele fenestration, 40 for retroperitoneal para-aortic lymphadenectomy and 187 for other operations. The complications were evaluated, listed accordin g to the anatomical specificity and grouped with respect to the surgical st ep during laparoscopy. Results: A total of 107 complications (4.4%) occurred. The re-intervention rate was 0.8% and the mortality rate was 0.08%. The complication rate depen ded on the difficulty of the procedure and averaged 1.0, 3.9 and 9.2%, resp ectively, for easy, difficult and very difficult operations. The majority w ere vascular injuries (1.7%) and visceral lesions (1.1%) followed by compli cations of healing and infection (0.8%). Only 0.2% of complications was ass ociated with the access technique (trocar insertion), whereas most occurred during dissection (2.9%). The complication rate was 13.3% for the first 10 0 procedures and subsequently averaged 3.6%. Conclusions: Critical documentation of experience from several institutions , especially for an analysis of complications of urological laparoscopy, is important for the development of this surgical technique. The overall comp lication rate is comparable to other specialties. Future technical developm ents in trocar insertion, tissue dissection and control of bleeding with ou r improved training program will further reduce the complication rate.