Background: Laparoscopic surgery in children has expanded from being primarily diagnostic to more complex reconstructive procedures. Complication rates are low (3-5%), however, they can have significant clinical consequences. This study aims to define the patterns and risk factors for complications in children undergoing laparoscopic urological surgery.
Methods: A retrospective analysis of all conventional and robotic-assisted laparoscopic urological procedures performed at our institution from 1995 to 2005 was conducted. Complications were categorized and graded based upon Clavien’s classification. Contributing factors such surgeon experience were taken evaluated. Statistical analysis was performed using the t-test and Fisher exact test.
Results: 862 laparoscopic procedures were evaluated. Overall, there was a 1.9% (16) complication rate. Complications related to access occurred in 8 of 383 cases using Veress access (0.021%) in contrast to 3 of 450 cases using open access (0.007%) (p=0.12, Fisher exact). The rate of grade III or IV complications associated with access was identical between open (0.7%) or Veress technique (0.8%). Complications included: preperitoneal insufflations (0.7%); vessel injury (0.4%); small bowel injury (0.3%); bleeding requiring conversion (0.1%); spermatic vessel transection (0.1%); bladder perforation (0.1%) and vas deferens transection (0.1%). Surgeons who had performed less than 150 laparoscopic surgeries had a higher risk of complications (p=0.043) and had more significant complications. Surgeons performing more than 12 laparoscopic cases per year had a significantly lower complication rate than those performing fewer than 12 (p = 0.03).
Conclusions: The low complication risk demonstrated in this series indicates that laparoscopic procedure are safe and have an acceptable complication rate, as seen in the literature, but that there is a potential risk of significant injury and that important determinants of surgical outcome include experience and access technique. Most, if not all complications are preventable with proper adherence to technique, practice and education.