• Taishin Ito, Shinji Kusunoki, and Masashi Kawamoto.
• Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551.
• Masui. 2011 Feb 1; 60 (2): 142-6.

BackgroundRetroperitoneal laparoscopic surgery has recently become a common procedure for urological fields. We investigated the incidence of respiratory complications and their background during retroperitoneal laparoscopic surgical procedures performed in the kidney position.MethodsWe prospectively enrolled 51 patients undergoing urological retroperitoneal laparoscopic surgery, and assessed perioperative respiratory complications using postoperative chest x-ray (CXR) and physical examinations.ResultsCXR revealed abnormalities in 32 patients (63%), including atelectasis in 22 (43%), pneumomediastinum in 8 (16%), and subcutaneous emphysema in 4 (8%). All of the atelectasis cases occurred in a middle or inferior robe, or a lingular segment of the lower lung in the lateral decubitus position. Furthermore, atelectasis occurred chiefly in older patients or in those who underwent right side surgical procedures, while pneumomediastinum was more common in left side procedures. One case was switched to an open laparotomy procedure because of possible pneumothorax; however, postoperative respiratory status was stable in all patients.ConclusionsRespiratory complications, such as atelectasis or pneumomediastinum, occurred in more than half of the patients after urological retroperitoneal laparoscopic surgical procedures in the kidney position. Careful perioperative management and postoperative CXR examinations are essential for early detection of such potentially life-threatening complications.

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