Advertisement

Nephrectomy

  • Benjamin T. Waldorf
  • David Canes
Chapter

Abstract

Our objective in writing this chapter is to provide the practicing urologist with an overview of the complications that can occur during and after robotic nephrectomy. Much of what is known about complications of minimally invasive nephrectomy is derived from the laparoscopic nephrectomy literature. Conversely, there are a paucity of studies focused specifically on complications of robotic nephrectomy. While robotic nephrectomy and laparoscopic nephrectomy are different surgical approaches, there is a significant overlap in both surgical technique and anatomic dissection, and we feel that extrapolation from the laparoscopic nephrectomy literature is valuable.

This chapter aims to address complications of robotic nephrectomy in a chronological sequence as they would be encountered by the surgeon. Beginning with patient selection, comorbid risk factors, and preoperative evaluation, we proceed to complications related to perioperative factors such as patient positioning and pharmacologic prophylaxis. Intraoperative complications are broken down by etiology. For each intraoperative complication, we discuss the typical presentation, literature review, and management strategies.

Keywords

Nephrectomy Robotic Robot assisted Complication Injury Vascular Bowel 

References

  1. 1.
    Robson CJ, Churchill RM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969;101(3):297–301.CrossRefPubMedGoogle Scholar
  2. 2.
    Chow WH, Devesa SS, Warren JL, Jr F. Rising incidence of renal cell cancer in the United States. JAMA. 1999;281(17):1628–31.CrossRefPubMedGoogle Scholar
  3. 3.
    SEER stat fact sheets: kidney and renal pelvis cancer. Available at: https://seer.cancer.gov/statfacts/html/kidrp.html.
  4. 4.
    Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Zini L, Perrotte P, Capitanio U, Jeldres C, Shariat SF, Antebi E, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009;115(7):1465–71.CrossRefPubMedGoogle Scholar
  6. 6.
    Novick A, Campbell S, Belldegrun A, Blute ML, Chow GH, Derweesh IH, et al. Guideline for management of the clinical stage 1 renal mass. American Urological Association website. Available at: https://www.auanet.org/common/pdf/education/clinical-guidance/Renal-Mass.pdf.
  7. 7.
    Ljungberg B, Bensalah K, Bex A, Canfield S, Giles RH, Hora M, et al. European Association of Urology guidelines for renal cell carcinoma. EAU Website. Available at: https://uroweb.org/guideline/renal-cell-carcinoma/.
  8. 8.
    Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy. N Engl J Med. 1991;324(19):1370–1.PubMedGoogle Scholar
  9. 9.
    Kingler DW, Hemstreet GP, Balaji KC. Feasibility of robotic radical nephrectomy—initial results of single-institution pilot study. Urology. 2005;65(6):1086–9.CrossRefGoogle Scholar
  10. 10.
    Permpongkosol S, Link RE, Su L, Romero FR, Jarrett TW, Kavoussi LR. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J Urol. 2007;177:580–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Pareek G, Hedican SP, Gee JR, Bruskewitz RC, Nakada SY. Meta-analysis of the complications of laparoscopic renal surgery: comparison of procedures and techniques. J Urol. 2006;175(4):1208–13.CrossRefPubMedGoogle Scholar
  12. 12.
    Asimakopoulos AD, Miano R, Annino F, Micali S, Spera E, Iorio B, et al. Robotic radical nephrectomy for renal cell carcinoma: a systematic review. BMC Urol. 2014;14:75.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS, et al. NCCN clinical practice guidelines in oncology for kidney cancer. NCCN website. Available at: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf.
  14. 14.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Cushman M, Das SR, et al. American Heart Association Heart Disease and Stroke Statistics 2016 Update. AHA website. Available at: https://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_480110.pdf.
  15. 15.
    Malkoc E, Maurice MJ, Kara O, Ramirez D, Caputo PA, Kaouk JK, et al. Robot-assisted approach approves surgical outcomes in obese patients undergoing partial nephrectomy. BJU Int. 2016. [Epub ahead of print].Google Scholar
  16. 16.
    Abdullah N, Dalela D, Barod R, Larson J, Johnson M, Mass A, et al. Robotic partial nephrectomy for renal tumors in obese patients: perioperative outcomes in a multi-institutional analysis. Can Urol Assoc J. 2015;9:E859–62.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ioffe E, Hakimi AA, Oh SK, Agalliu I, Ginzburg N, Williams SK, et al. Effect of visceral obesity on minimally invasive partial nephrectomy. Urology. 2013;82(3):612–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Rogde AJ, Gudbrandsdottir G, Hjelle KM, Sand KE, Bostad L, Beisland C. Obesity is associated with an improved cancer-specific survival, but an increased rate of post-operative complications after surgery for renal cell carcinoma. Scand J Urol Nephrol. 2012;46(5):348–57.CrossRefPubMedGoogle Scholar
  19. 19.
    Pariser JJ, Pearce SM, Patel SG, Anderson BB, Packiam VT, Shalhav A, et al. Rhabdomyolysis after major urologic surgery: epidemiology, risk factors and outcomes. Urology. 2015;85(6):1328–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Wolf JS, Bennett CJ, Dmochowski RR, Hollenbeck BK, Pearle MS, Schaeffer AJ. Best practice policy statement on urologic surgery antimicrobial prophylaxis (2008). AUA website. Available at: https://www.auanet.org/common/pdf/education/clinical-guidance/Antimicrobial-Prophylaxis.pdf.
  21. 21.
    Stevens J, Nichelson E, Linehan WM, Thompson N, Liewehr D, Venzon D, et al. Risk factors for skin breakdown after renal and adrenal surgery. Urology. 2004;64(2):246–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Deane LA, Lee HJ, Box GN, Abraham JB, Abdelshehid CS, Elchico ER, et al. Third place: flank position is associated with higher skin-to-surface interface pressures in men versus women: implications for laparoscopic renal surgery and the risk of rhabdomyolysis. J Endourol. 2008;22(6):1147–51.CrossRefPubMedGoogle Scholar
  23. 23.
    Targa L, Droghetti L, Caggese G, Zatelli R, Roccella P. Rhabdomyolysis and operating position. Anaesthesia. 1991;46(2):141–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Glassman DT, Merriam WG, Trabulsi EJ, Byrne D, Gomella L. Rhabdomyolysis after laparoscopic nephrectomy. JSLS. 2007;11(4):432–7.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Sukhu T, Krupiski TL. Patient positioning and prevention of injuries in patients undergoing laparoscopic urologic procedures. Curr Urol Rep. 2014;15(4):398.CrossRefPubMedGoogle Scholar
  26. 26.
    Wolf JS Jr, Marcovich R, Gill IS, Sung GT, Kavoissi LR, Clayman RV, et al. Survey of neuromuscular injuries to the patient and surgeon during urologic laparoscopic surgery. Urology. 2000;55(6):831–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Ahmad G, Gent G, Henderson D, O’Flynn H, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2015;8:CD006583. doi: 10.1002/14651858.CD006583.pub4. Review.
  28. 28.
    Azevedo JL, Azevedo OC, Miyahira SA, Miguel GP, Becker OM, Hypolito OH, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23(7):1428–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Lee Z, Cadillo-Chavez R, Lee DI, Llukani E, Eun D. The technique of single stage pure robotic nephroureterectomy. J Endourol. 2013;27(2):189–95.CrossRefPubMedGoogle Scholar
  30. 30.
    Eun D, Bhandari A, Boris R, Rogers C, Bhandari M, Menon M. Concurrent upper and lower tract robotic surgery: strategies for success. BJU Int. 2007;100(5):1121–5.PubMedGoogle Scholar
  31. 31.
    Rogers CG, Laungani R, Bhandari A, Krane LS, Eun D, Menon M, et al. Maximizing console surgeon independence during robot-assisted renal surgery by using the fourth arm and TilePro. J Endourol. 2009;23(1):115–21.CrossRefPubMedGoogle Scholar
  32. 32.
    Colombo JR Jr, Haber GP, Fergany A, Desai MM, Kaouk JH, Gill IS, et al. Complications of laparoscopic surgery for urological cancer: a single institution study. J Urol. 2007;178(3 Pt 1):786–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Schwartz MJ, Faiena I, Cinman N, Kucharczyk J, Richstone L, Kavoussi LR, et al. Laparoscopic bowel injury in retroperitoneal surgery: current incidence and outcomes. J Urol. 2010;184(2):589–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Bishoff JT, Allaf ME, Kirkels W, Moore RG, Kavoussi LR, Schroder F. Laparoscopic bowel injury: incidence and clinical presentation. J Urol. 1999;161(3):887–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Meraney AM, Samee AA, Gill IS. Vascular and bowel complications during retroperitoneal laparoscopic surgery. J Urol. 2002;168(5):191–4.CrossRefGoogle Scholar
  36. 36.
    Franko J, O’Connell BG, Mehall JR, Harper SG, Nejman JH, Fassler SA, et al. The influence of prior abdominal operations on conversion and complication rates in laparoscopic colorectal surgery. JSLS. 2006;10(2):169–75.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91(10):1253–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Zacchero M, Volpe A, Billia M, Tarabuzzi R, Varvello F, Terrone C, et al. Transmesenteric approach for left transperitoneal renal surgery: technique and experience. J Laparoendosc Adv Surg Tech A. 2012;22(2):176–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Hegde CV. Management of large bowel injury during laparoscopic surgery. J Obstet Gynaecol India. 2012;62(5):501–3.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Reich H, McGlynn F, Budin R. Laparoscopic repair of full-thickness bowel injury. J Laparoendosc Surg. 1991;1(2):119–22.CrossRefPubMedGoogle Scholar
  41. 41.
    Kaplan JR, Lee Z, Eun DD, Reese AC. Complications of minimally invasive surgery and their management. Curr Urol Rep. 2016;17(6):47.CrossRefPubMedGoogle Scholar
  42. 42.
    Meraney AM, Samee AA, Gill IS. Vascular and bowel complications during retroperitoneal laparoscopic surgery. J Urol. 2002;168(5):1941–4.CrossRefPubMedGoogle Scholar
  43. 43.
    Ono Y, Katoh N, Kinukawa T, Matsuura O, Ohshima S. Laparoscopic radical nephrectomy: the Nagoya experience. J Urol. 1997;158(3 pt 1):719–23.PubMedGoogle Scholar
  44. 44.
    Joshi SS, Sundaram CP. Small bowel injury during laparoendoscopic single-site surgery for simple nephrectomy. JSLS. 2013;17(1):167–9.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Shoskes DA, McMahon AW. Renal physiology and pathophysiology. In: Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier; 2012.Google Scholar
  46. 46.
    Anderson JK, Cadeddu JA. Surgical anatomy of the retroperitoneum, adrenals, kidneys, and ureters. In: Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier; 2012.Google Scholar
  47. 47.
    Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol. 2004;171(1):130–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Kouba E, Smith AM, Derksen JE, Gunn K, Wallen E, Pruthi ES. Efficacy and safety of en bloc ligation of renal hilum during laparoscopic nephrectomy. Urology. 2007;69(2):226–9.CrossRefPubMedGoogle Scholar
  49. 49.
    Soulie M, Salomon L, Sequin P, Mervant C, Mouly P, Abbou CC, et al. Multi-institutional study of complications in 1085 laparoscopic urologic procedures. Urology. 2001;58(6):889–903.CrossRefGoogle Scholar
  50. 50.
    Parsons JK, Varkarakis I, Rha KH, Jarrett TW, Pinto PA, Kavoussi LR. Complications of abdominal urologic laparoscopy: longitudinal five-year analysis. Urology. 2004;63(1):27–32.CrossRefPubMedGoogle Scholar
  51. 51.
    Nelson EC, Evans CP. Complications of nephrectomy. In: Complications of urologic surgery. 5th ed. Philadelphia: Elseiver; 2010.Google Scholar
  52. 52.
    Canes D, Aron M, Nguyen MM, Winans C, Chand B, Gill IS. Common bile duct injury during urologic laparoscopy. J Endourol. 2008;22(7):1483–4.CrossRefPubMedGoogle Scholar
  53. 53.
    Varkarakis IM, Allaf ME, Bhayani SB, Inagaki T, Kavoussi LR, Jarrett TW, et al. Pancreatic injuries during laparoscopic urologic surgery. Urology. 2004;64(6):1089–93.CrossRefPubMedGoogle Scholar
  54. 54.
    Cooper CS, Cohen MB, Donovan JF Jr. Splenectomy complicating left nephrectomy. J Urol. 1996;155(1):30–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Chung BI, Desai MM, Gill IS. Management of intraoperative splenic injury during laparoscopic urological surgery. BJU Int. 2011;108(4):572–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Canby-Hagino ED, Morey AF, Jatoi I, Perahia B, Bishoff JT. Fibrin sealant treatment of splenic injury during open and laparoscopic left radical nephrectomy. J Urol. 2000;164(6):2004–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Biggs G, Hafron J, Feliciano J, Hoenig DM. Treatment of splenic injury during laparoscopic nephrectomy with BioGlue, a surgical adhesive. Urology. 2005;66(4):882.CrossRefPubMedGoogle Scholar
  58. 58.
    Giri SK, Abdelrahman M, Flood HD. Experience with sliding-clip splenorrhaphy for splenic injury during radical nephrectomy. Can Urol Assoc J. 2015;9(7–8):E476–9.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Pasternack MS. Preventing severe infection after splenectomy, beyond the basics. In: Up To Date, Waltham. Accessed 4 Nov 2016.Google Scholar
  60. 60.
    Capocasale E, Iaria M, Vistoli F, Signori S, Mazzoni MP, Boggi U, et al. Incidence, diagnosis, and treatment of chylous leakage after laparoscopic live donor nephrectomy. Transplantation. 2012;93(1):82–6.CrossRefPubMedGoogle Scholar
  61. 61.
    Tiong HY, Goel RK, White WM, Goldfarb DA, Kaouk JH. Chylous ascites after laparoscopic donor nephrectomy. Asian J Endosc Surg. 2015;8(1):34–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Kim BS, Yoo ES, Kim TH, Kwon TG. Chylous ascites as a complication of laparoscopic nephrectomy. J Urol. 2010;184(2):570–4.CrossRefPubMedGoogle Scholar
  63. 63.
    Kobayashi M, Kambara T, Kamai T. A rare complication of chylous leakage after open partial nephrectomy successfully resolved by somatostatin analogue. Urol Case Rep. 2015;3(6):195–7.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Nishizawa K, Ito N, Yamamoto S, Kamoto T, Ogawa O. Successful laparoscopic management of chylous ascites following laparoscopic radical nephrectomy. Int J Urol. 2006;13(5):619–21.CrossRefPubMedGoogle Scholar
  65. 65.
    Jairath A, Singh A, Ganpule A, Mishra S, Sabnis R, Desai M. Management protocol for chylous ascites after laparoscopic nephrectomy. Urology. 2015;86(3):532–28.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of UrologyTemple University HospitalPhiladelphiaUSA
  2. 2.Department of UrologyLahey Hospital and Medical CenterBurlingtonUSA

Personalised recommendations