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Inicio Actas Urológicas Españolas (English Edition) Complications associated with laparoscopic adrenalectomy: Description and standa...
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Vol. 38. Issue 7.
Pages 445-450 (September 2014)
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Vol. 38. Issue 7.
Pages 445-450 (September 2014)
Original article
Complications associated with laparoscopic adrenalectomy: Description and standardized assessment
Descripción y evaluación estandarizada de complicaciones asociadas a adrenalectomía laparoscópica
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O.A. Castilloa,b,
Corresponding author
octavio.castillo@indisa.cl

Corresponding author.
, A. Rodríguez-Carlina, J. López-Vallejoa, V. Borgnab
a Departamento de Urología, Clínica INDISA, Santiago, Chile
b Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile
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Tables (6)
Table 1. Clavien–Dindo classification of surgical complications.
Table 2. Satava classification of intraoperative complications.
Table 3. Demographic characteristics of the patients and perioperative results.
Table 4. Intraoperative complications in our series of 344 LAs.
Table 5. Postoperative complications in our series of 344 LAs.
Table 6. Series of laparoscopic adrenalectomies.
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Abstract
Objective

Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series.

Materials and methods

322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumor. In order to evaluate perioperative complications, data were collected prospectively and analyzed retrospectively. Intraoperative complications were defined using Satava classification and Clavien–Dindo classification of postoperative complications.

Results

Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (0.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V).

Conclusions

Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events.

Keywords:
Adrenalectomy
Laparoscopic
Complications
Resumen
Objetivo

La adrenalectomía laparoscópica (AL) es el procedimiento de elección para el manejo quirúrgico de las masas adrenales. Nuestro objetivo es presentar una evaluación estandarizada de las complicaciones perioperatorias en una serie de AL.

Material y métodos

Entre los meses de junio de 1993 a septiembre de 2012 se realizaron 344 AL en pacientes con diagnóstico de tumor suprarrenal, de forma consecutiva. Los datos fueron recolectados de forma prospectiva y analizados retrospectivamente para evaluar las complicaciones perioperatorias. Las complicaciones intraoperatorias se definieron utilizando la clasificación de Satava y las complicaciones postoperatorias según la clasificación de Clavien-Dindo.

Resultados

Veinticinco AL presentaron complicaciones perioperatorias (7,3%), 11 fueron intraoperatorias (3,2%), siendo en su mayoría lesiones vasculares y del diafragma (Satava grado 2) y 14 postoperatorias (4,1%). Seis pacientes presentaron complicaciones que precisaron intervención quirúrgica (Clavien IIIa/IIIb) y/o soporte en la unidad de cuidados intensivos (Clavien IV). Hubo una conversión a cirugía abierta (0,3%). A pesar de que se tomaron todas las medidas endocrinológicas preoperatorias adecuadas, un paciente portador de un feocromocitoma desarrolló en el intraoperatorio una crisis hipertensiva incontrolable y paro cardiorrespiratorio recuperado, falleciendo a los 5 días por un infarto cerebral masivo (Clavien V).

Conclusiones

Las complicaciones quirúrgicas necesitan de un criterio común de estandarización mediante la aplicación combinada de 2 herramientas. Creemos que este concepto de evaluación de la morbilidad de la cirugía debe ser aplicado de forma sistemática, y de esta manera permitir a los cirujanos lograr un nuevo estándar de informes de eventos adversos perioperatorios refinado, conciso y comparativo.

Palabras clave:
Adrenalectomía
Laparoscopia
Complicaciones

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