UroToday - Overall complications with laparoscopic renal surgery are far more acutely devastating than those with laparoscopic prostate surgery. While the latter is more commonly associated with bowel injury (1.2%), the former is more commonly associated with vascular injury (2.8%) and mortality (0.2%).1,2

In this review of 1,123 laparoscopic renal procedures, 0.8% of patients underwent postoperative (i.e. within 5 days) exploration for bleeding. Of note, among those patients who underwent exploration less than 10 hours after surgery, arterial bleeding was found (3 adrenal vessels and one renal artery) and treated.

Unfortunately, the authors do not specify which adrenal was affected in these 3 patients; but in my experience the right adrenal is more susceptible to this complication than the left adrenal. All of these patients had hypotension and more than a 10.5% decrease in their hematocrit from initial postoperative value to the repeat value.

On the other hand, the patients who were explored later than 10 hours, while they had mild hypotension and tachycardia, the hematocrit drifted down slowly and only fell an average of 5.8%. When they were explored, only a diffuse oozing was found. Of note, the patients with delayed exploration had all received an average of 5 units of blood. Also, whereas the acutely bleeding patients underwent an open procedure, the delayed hemorrhage group underwent a laparoscopic procedure (4 out of 5 cases).

Paradoxically, the average hospital was 8 days in the acutely bleeding group that had open exploration and 12 days in those patients undergoing delayed exploration, despite the fact that 4 of the 5 had a laparoscopic exploration. It is of interest, that evacuation of a hematoma despite absence of a defined source of bleeding seems to result in cessation of "oozing" and stabilization of the patient.

By Ralph V. Clayman, M.D.
1Parsons, J. K., Varkarakis, I., Rha, K. H., Jarrett, T. W., Pinto, P. A., and Kavoussi, L. R.: Complications of abdominal urologic laparoscopic surgery: longitudinal five-year analysis. Urology 63: 27, 2004.

2Vallancien, G., Cathelineau, X., Baumert, H., Doublet, J.D., and Guillonneau, B.: Complications of transperitoneal laparoscopic surgery in Urology: review of 1,311 procedures at a single center. J. Urol. 168: 23-26, 2002.

Reference:
S. B. Bhayani, R. E. Link, D. V. Makarov, T. W. Jarrett, and L. R. Kavoussi.
J. Urology 175: 2137-2139, June 2006
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