Complications during the initial experience with laparoendoscopic single-site pyeloplasty.

Best, Sara L; Donnally, Chester; Mir, Saad A; Tracy, Chad R; Raman, Jay D; Cadeddu, Jeffrey A

OBJECTIVE • To review our initial series of laparoendoscopic single-site (LESS) pyeloplasties, focusing on 30-day complication rates as an indicator of learning curve, and to define the expected morbidity. PATIENTS AND METHODS • The study comprised 28 patients who underwent LESS pyeloplasty by a single surgeon from October 2007. • A chart review was undertaken to identify the complications that occurred within the first 30 days after surgery. RESULTS • The mean operating time was 197 min. • Seven patients (25%) experienced a total of eight complications. Four patients required nephrostomy tube placement (14%) during the early postoperative period, two for symptomatic obstruction despite the ureteral stent and two for a urine leak. Another had urine leakage that resolved spontaneously after she went home with the surgical drain for 1 week. One patient (4%) developed a retroperitoneal haematoma and required blood transfusion and one had haematuria that prolonged hospital stay by 2 days. • Of the patients experiencing complications, 71% were in the first ten cases. Only two complications occurred in the subsequent 18 patients. CONCLUSIONS • The LESS pyeloplasty procedure is a technically difficult, even for an experienced laparoscopic surgeon and the surgical challenges of this technique may translate to a higher complication rate for LESS than for conventional laparoscopic pyeloplasty early in the learning curve. However, within a relatively few cases, the complication rate is similar to that of standard laparoscopic pyeloplasty. • Additional follow-up is required to determine the long-term success rate.