Urological laparoendoscopic single site surgery

Multi-institutional analysis of risk factors for conversion and postoperative complications

Riccardo Autorino, Jihad H. Kaouk, Rachid Yakoubi, Koon Ho Rha, Robert J. Stein, Wesley White, Jens Uwe Stolzenburg, Luca Cindolo, Evangelos Liatsikos, Soroush Rais-Bahrami, Alessandro Volpe, Deok Hyun Han, Ithaar H. Derweesh, Seung Wook Lee, Aly M. Abdel-Karim, Anibal Branco, Francesco Greco, Mohamad Allaf, Rene Sotelo, Panagiotis Kallidonis & 20 others Byong Chang Jeong, Sara Best, Wassim Bazzi, Phillip Pierorazio, Salah Elsalmy, Abhay Rane, Woong Kyu Han, Bo Yang, Luigi Schips, Wilson R. Molina, Paolo Fornara, Carlo Terrone, Camilo Giedelman, Joo Yong Lee, Sebastien Crouzet, Georges Pascal Haber, Lee Richstone, Sun Yinghao, Fernando J. Kim, Jeffrey A. Cadeddu

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery. Materials and Methods: The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications. Results: Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p = 0.02), pelvic surgery (p <0.001), robotic approach (p <0.001), high difficulty score (p = 0.004), extended operative time (p = 0.03) and an intraoperative complication (p = 0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p = 0.03), high difficulty score (p = 0.002) and extended operative time (p = 0.02) predicted high grade complications. Conclusions: Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.

Original languageEnglish (US)
Pages (from-to)1989-1994
Number of pages6
JournalJournal of Urology
Volume187
Issue number6
DOIs
StatePublished - Jun 1 2012

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Robotics
Operative Time
Laparoscopy
Logistic Models
Intraoperative Complications
Patient Safety
Patient Selection
Statistical Factor Analysis
Cohort Studies
Incidence

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Urological laparoendoscopic single site surgery : Multi-institutional analysis of risk factors for conversion and postoperative complications. / Autorino, Riccardo; Kaouk, Jihad H.; Yakoubi, Rachid; Rha, Koon Ho; Stein, Robert J.; White, Wesley; Stolzenburg, Jens Uwe; Cindolo, Luca; Liatsikos, Evangelos; Rais-Bahrami, Soroush; Volpe, Alessandro; Han, Deok Hyun; Derweesh, Ithaar H.; Lee, Seung Wook; Abdel-Karim, Aly M.; Branco, Anibal; Greco, Francesco; Allaf, Mohamad; Sotelo, Rene; Kallidonis, Panagiotis; Jeong, Byong Chang; Best, Sara; Bazzi, Wassim; Pierorazio, Phillip; Elsalmy, Salah; Rane, Abhay; Han, Woong Kyu; Yang, Bo; Schips, Luigi; Molina, Wilson R.; Fornara, Paolo; Terrone, Carlo; Giedelman, Camilo; Lee, Joo Yong; Crouzet, Sebastien; Haber, Georges Pascal; Richstone, Lee; Yinghao, Sun; Kim, Fernando J.; Cadeddu, Jeffrey A.

In: Journal of Urology, Vol. 187, No. 6, 01.06.2012, p. 1989-1994.

Research output: Contribution to journalArticle

Autorino, R, Kaouk, JH, Yakoubi, R, Rha, KH, Stein, RJ, White, W, Stolzenburg, JU, Cindolo, L, Liatsikos, E, Rais-Bahrami, S, Volpe, A, Han, DH, Derweesh, IH, Lee, SW, Abdel-Karim, AM, Branco, A, Greco, F, Allaf, M, Sotelo, R, Kallidonis, P, Jeong, BC, Best, S, Bazzi, W, Pierorazio, P, Elsalmy, S, Rane, A, Han, WK, Yang, B, Schips, L, Molina, WR, Fornara, P, Terrone, C, Giedelman, C, Lee, JY, Crouzet, S, Haber, GP, Richstone, L, Yinghao, S, Kim, FJ & Cadeddu, JA 2012, 'Urological laparoendoscopic single site surgery: Multi-institutional analysis of risk factors for conversion and postoperative complications', Journal of Urology, vol. 187, no. 6, pp. 1989-1994. https://doi.org/10.1016/j.juro.2012.01.062
Autorino, Riccardo ; Kaouk, Jihad H. ; Yakoubi, Rachid ; Rha, Koon Ho ; Stein, Robert J. ; White, Wesley ; Stolzenburg, Jens Uwe ; Cindolo, Luca ; Liatsikos, Evangelos ; Rais-Bahrami, Soroush ; Volpe, Alessandro ; Han, Deok Hyun ; Derweesh, Ithaar H. ; Lee, Seung Wook ; Abdel-Karim, Aly M. ; Branco, Anibal ; Greco, Francesco ; Allaf, Mohamad ; Sotelo, Rene ; Kallidonis, Panagiotis ; Jeong, Byong Chang ; Best, Sara ; Bazzi, Wassim ; Pierorazio, Phillip ; Elsalmy, Salah ; Rane, Abhay ; Han, Woong Kyu ; Yang, Bo ; Schips, Luigi ; Molina, Wilson R. ; Fornara, Paolo ; Terrone, Carlo ; Giedelman, Camilo ; Lee, Joo Yong ; Crouzet, Sebastien ; Haber, Georges Pascal ; Richstone, Lee ; Yinghao, Sun ; Kim, Fernando J. ; Cadeddu, Jeffrey A. / Urological laparoendoscopic single site surgery : Multi-institutional analysis of risk factors for conversion and postoperative complications. In: Journal of Urology. 2012 ; Vol. 187, No. 6. pp. 1989-1994.
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abstract = "Purpose: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery. Materials and Methods: The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications. Results: Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3{\%} of cases. The overall conversion rate was 19.6{\%} with 14.6{\%}, 4{\%} and 1.1{\%} of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p = 0.02), pelvic surgery (p <0.001), robotic approach (p <0.001), high difficulty score (p = 0.004), extended operative time (p = 0.03) and an intraoperative complication (p = 0.001). A total of 120 postoperative complications occurred in 109 patients (9.4{\%}) with major complications in only 2.4{\%} of the entire cohort. Reconstructive procedure (p = 0.03), high difficulty score (p = 0.002) and extended operative time (p = 0.02) predicted high grade complications. Conclusions: Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.",
author = "Riccardo Autorino and Kaouk, {Jihad H.} and Rachid Yakoubi and Rha, {Koon Ho} and Stein, {Robert J.} and Wesley White and Stolzenburg, {Jens Uwe} and Luca Cindolo and Evangelos Liatsikos and Soroush Rais-Bahrami and Alessandro Volpe and Han, {Deok Hyun} and Derweesh, {Ithaar H.} and Lee, {Seung Wook} and Abdel-Karim, {Aly M.} and Anibal Branco and Francesco Greco and Mohamad Allaf and Rene Sotelo and Panagiotis Kallidonis and Jeong, {Byong Chang} and Sara Best and Wassim Bazzi and Phillip Pierorazio and Salah Elsalmy and Abhay Rane and Han, {Woong Kyu} and Bo Yang and Luigi Schips and Molina, {Wilson R.} and Paolo Fornara and Carlo Terrone and Camilo Giedelman and Lee, {Joo Yong} and Sebastien Crouzet and Haber, {Georges Pascal} and Lee Richstone and Sun Yinghao and Kim, {Fernando J.} and Cadeddu, {Jeffrey A.}",
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T1 - Urological laparoendoscopic single site surgery

T2 - Multi-institutional analysis of risk factors for conversion and postoperative complications

AU - Autorino, Riccardo

AU - Kaouk, Jihad H.

AU - Yakoubi, Rachid

AU - Rha, Koon Ho

AU - Stein, Robert J.

AU - White, Wesley

AU - Stolzenburg, Jens Uwe

AU - Cindolo, Luca

AU - Liatsikos, Evangelos

AU - Rais-Bahrami, Soroush

AU - Volpe, Alessandro

AU - Han, Deok Hyun

AU - Derweesh, Ithaar H.

AU - Lee, Seung Wook

AU - Abdel-Karim, Aly M.

AU - Branco, Anibal

AU - Greco, Francesco

AU - Allaf, Mohamad

AU - Sotelo, Rene

AU - Kallidonis, Panagiotis

AU - Jeong, Byong Chang

AU - Best, Sara

AU - Bazzi, Wassim

AU - Pierorazio, Phillip

AU - Elsalmy, Salah

AU - Rane, Abhay

AU - Han, Woong Kyu

AU - Yang, Bo

AU - Schips, Luigi

AU - Molina, Wilson R.

AU - Fornara, Paolo

AU - Terrone, Carlo

AU - Giedelman, Camilo

AU - Lee, Joo Yong

AU - Crouzet, Sebastien

AU - Haber, Georges Pascal

AU - Richstone, Lee

AU - Yinghao, Sun

AU - Kim, Fernando J.

AU - Cadeddu, Jeffrey A.

PY - 2012/6/1

Y1 - 2012/6/1

N2 - Purpose: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery. Materials and Methods: The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications. Results: Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p = 0.02), pelvic surgery (p <0.001), robotic approach (p <0.001), high difficulty score (p = 0.004), extended operative time (p = 0.03) and an intraoperative complication (p = 0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p = 0.03), high difficulty score (p = 0.002) and extended operative time (p = 0.02) predicted high grade complications. Conclusions: Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.

AB - Purpose: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery. Materials and Methods: The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications. Results: Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p = 0.02), pelvic surgery (p <0.001), robotic approach (p <0.001), high difficulty score (p = 0.004), extended operative time (p = 0.03) and an intraoperative complication (p = 0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p = 0.03), high difficulty score (p = 0.002) and extended operative time (p = 0.02) predicted high grade complications. Conclusions: Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.

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DO - 10.1016/j.juro.2012.01.062

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SP - 1989

EP - 1994

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JF - Journal of Urology

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