Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study
Authors: Territo Angelo , Di Buono Giuseppe , Buscemi Salvatore , Mantica Guglielmo , Falco Vincenzo , Palacios Vital Hevia , Verri Paolo , Antelo Rodrigo Antelo , Rosas-Nava Jesus Emmanuel , Crisan Nicolae , Andras Iulia , Medas Fabio , Amato Giuseppe , Romano Giorgio , Breda Alberto , Agrusa Antonino ,   i-CLARAS (intraoperative Complication in Laparoscopic Renal and Adrenal Surgery) Research Collaborative Study Group, Agresta Ferdinando , Adelfio Nicoletta , Amparore Danilo , Anania Gabriele , Badalamenti Giuseppe , Bagolini Francesco , Barletta Gabriele , Bracale Umberto , Buzoianu Maximilian , Calò Pietro Giorgio , Canu Gian Luigi , Cicero Giuseppe , Citarrella Roberto , Coletta Pietro , Corcione Francesco , Cuccurullo Diego , Cucinella Gaspare , Cupido Francesco , D’Angelo Francesco , Feo Carlo , Gutiérrez Ana Domínguez , Gallioli Andrea , Gaya Jose Maria , Geraci Girolamo , Gonzales-Mendez Gerardo Tena , Guerrieri Mario , Gullo Giuseppe , Iacone Bianca , Salgado Isaac Roberto Labra , Licitra Edelweiss Giulia , Curtis David Lopez , Plaza José Antonio López , Micheli Matilde , Montori Giulia , Nevo Nadav , Oppici Dario , Arellano Leandro , Ortenzi Monica , Palmieri Miriam , Piccione Antonio , Porpiglia Francesco , Raffaele Pablo , Reggio Stefano , Romano Giorgio , Russo Gaia , Sanchez-Molina Raul , Gomez Isabel Sanz , Saverino Marta , Sibillla Maria Grazia , Silecchia Gianfranco , Stigliano Antonio , Tedesco Anna , Telecan Teodora , Terrone Carlo , Valerio Maria Rosaria , Vecco Francesco , Vella Roberta , Vitale Francesco 
Published: January 2024

The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications.