Complications of Laparoscopic and Robotic Urologic Surgery, 2010

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 openandlaparoscopicsurgeryforthelaparoscopicallynaïvesurgeon.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.

Section 1: General and Medical Considerations: Chapter 1: Physiology of Laparoscopy and Pneumoperitoneum. Chapter 2: Anesthesia and Management of Anesthetic Complications of Laparoscopic Urological Surgery Chapter 3: Metabolic and Renal Complications and Immunologic Implications of Laparoscopic Urologic Surgery Chapter 4: Positional and Neuromuscular Complications of Laparoscopic and robotic Urologic Surgery. Section 2: Surgical Complications: Chapter 5: Vascular Complications of Laparoscopic and Robotic Urologic Surgery Chapter 6: Urinary and Urologic Complications of Laparoscopic and Robotic Urologic Surgery Chapter 7: Visceral and Gastrointestinal Complications of Laparoscopic Urologic Surgery. Chapter 8: Complications of Robotic Assisted Laparoscopic urologic Surgery: Iatrogenic and Doulogenic Section 3: Procedure Specific Complications I. Complications of Upper Tract Laparoscopic and Robotic Urologic Procedures Chapter 9: Complications of Laparoscopic and Robotic Adrenal Surgery Chapter 10: Complications of Laparoscopic Radical Nephrectomy and Nephroureterectomy Chapter 11: Complications of Laparoscopic Donor Nephrectomy Chapter 12: Complications of Laparoscopic Partial Nephrectomy Chapter 13: Complications of Robotic Partial Nephrectomy Chapter 14: Complications of Laparoscopic Retroperitoneal Lymph Node Dissection Chapter 15: Complications of Laparoscopic and Robotic Pyeloplasty Chapter 16: Complications of Laparoscopic and Robotic Ureteral Reconstructive Surgery II. Complications of Pelvic Laparoscopic and Robotic Surgery Chapter 17: Complications of Robotic Radical Prostatectomy Chapter 18: Methods and maneuvers for improving functional outcomes during robotic radical Prostatectomy Chapter 19: Complications of Laparoscopic and Robotic-Assisted Radical Cystectomy III: Special Considerations Chapter 20: Complications of Laparoscopic and Robotic Reconstructive Procedures for Urinary Incontinence and Pelvic Organ Prolapse Chapter 21: Complications of Single-port Laparoscopic and Robotic Urologic Surgery Chapter 22: Complications of Ablative Renal Procedures Chapter 23: Complications of Laparoscopic and Robotic Pediatric Urologic Surgery Chapter 24: Medicolegal Aspects of Minimally Invasive Urologic Surgery