Editing Robotic Partial Nephrectomy (section)

== Complications ==
Population-based data is preferentially described, rather than data from few surgeons.
*Overall rate of any complications: ≈10-25%[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752140/][https://pubmed.ncbi.nlm.nih.gov/29067427/]
** Rates of major complications (Clavien grades 3-5): ≈4%[https://pubmed.ncbi.nlm.nih.gov/29067427/]
* Median length of stay: ≈3 days[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752140/]
** ≈25% have LOS > 4 days[https://pubmed.ncbi.nlm.nih.gov/29067427/]

=== Intra-operative ===
* Bleeding
**≈6-20% transfusion rate[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752140/][https://pubmed.ncbi.nlm.nih.gov/29067427/]
* Injury to adjacent organ (bowel, diaphragm, liver, spleen, pancreas, ureter, bladder)
**Bowel injury 
***Intraoperative intestinal injury rates: ≈4%
***May occur during trocar placement or from cautery injury
***All injuries recognized intraoperatively require immediate repair and intraoperative general surgery consultation should be considered
***In the postoperative period, signs of a bowel injury could include port-site pain, nausea, vomiting, abdominal distension, fever and leucocytosis.
**Intraoperative ureteral or bladder injury rates: ≈4%
*Conversion to open surgery
*Conversion to radical nephrectomy
*Risks of general anesthesia
**DVT/PE rates: ≈1%

=== Early post-operative ===
* Infection
* Re-operation due to
** Bleeding
** Wound dehiscence
*Urine leak
**Should be suspected postoperatively if the drain output is elevated with elevated drain creatinine levels. The drain should be left in place and the urine output monitored. 
**A CT urogram may be ordered for continued leakage or symptoms to assess for a urinoma. 
**A percutaneous drain may need to be placed if there is a collection or the existing drain may need to be adjusted. 
**Resolution of the urinoma should be confirmed with follow-up imaging. 
**Retrograde placement of a ureteric stent should be an option if there is continued output or evidence of obstruction.

=== Late post-operative ===
* Incisional hernia
*Pseudoaneurysm
*Failure to cure
**Positive surgical margin ≈10%[https://pubmed.ncbi.nlm.nih.gov/29232025/]
*Need for secondary procedure e.g. to manage urine leak or pseudoaneurysm