Complications of Laparoscopic and Robotic Urologic Surgery

There has been an explosion in minimally invasive surgery (MIS) in urology. As surgicalsubspecialists,urologistswereslowtoembraceminimallyinvasivesurgery at its inception. However, in the last decade, the interest in MIS has grown ex- nentiallyinurology.Laparoscopicrenalproceduresarecommonplace,andmoreand more complex oncologic and reconstructive procedures are performed laparosc- ically. Much of this exponential growth has been due to the rapid dissemination ofrobotictechnology,speci?callyforprostatectomy.Soonafterward,roboticte- nology was applied to other complex lower tract oncologic and reconstructive procedures.Roboticassistancehasalsobeenappliedtouppertracturologicpro- duressuchaspyeloplastybutitsapplicationforpartialnephrectomyismorerecent. It has become apparent that robotic technology can serve as an interface between openandlaparoscopicsurgeryforthelaparoscopicallynaivesurgeon.Ithascertainly been shown to be so for prostatectomy, and whether the same pans out for partial nephrectomyisyettobeseen. As more experience is gained in MIS, more and more complex procedures are performedlaparoscopicallyandrobotically.Contrarytologicalexpectation,thein- denceofcomplicationshasindeedincreasedwithincreasingexperienceinMIS.This ispurelyare?ectionofthecomplexityoftheproceduresperformedratherthans- gical ineptitude. Increased surgical experience and surgeon volume with a certain procedurecandecreaseperioperativemorbidity.Asinopensurgery,complications willbeeverpresentinthelaparoscopicmanagementofourpatientsandcannotbe eradicatedinallinstances.Theycan,however,beavoidedandmeasurescanbetaken to decrease their incidence. Much of this knowledge is gained purely from sur- calexperience.Certainclinicalscenariosandcomorbiditiespredisposethepatientto complications.Speci?ctosurgicaltechnique,certainmaneuversincreasethelike- hoodofintra-operativeandperioperativecomplicationsandincreasethelikelihood ofadverseoutcomes.Onthecontrary,certainprecautionsandmaneuverscanserve topreventcomplications. This textbook is intended to familiarize the modern urologist with the common andthemoreeccentriccomplicationsoflaparoscopicandroboticurologicsurgery. RecognizedurologicexpertsinMIShavecontributedtomakingthisthe?rstc- prehensive textbook speci?cally dedicated to complications in minimally invasive urologic surgery. The book is divided into three speci?c parts. In the ?rst part, medical and general considerations are discussed.In the second part, generalized discussionofcommonsurgicalcomplicationsispresented.Complicationsspeci?cto roboticsurgeryingeneralareemphasizedinaseparateuniquechapter.Thethirdpart vii viii Preface is dedicated to procedure-speci?c complications. Complications of upper tract and lowertractlaparoscopicandroboticproceduresarediscussedindifferentsubsections. Inmostchapters,abriefdescriptionoftheprocedureisprovidedaswellasan- depthdiscussionofthediagnosisandmanagementofcomplicationsassociatedwith that particular procedure. In each chapter, a discussion of preventive measures is emphasized.Thelastsegmentinthissectiondealswithspecialtopicssuchassingle port surgery, ablative procedures, and pediatric laparoscopy. Finally, a compreh- sivechapteronmedico-legalimplicationsoflaparoscopicandrobotictechnologyis presented.