Prevention of perioperative complications of minimally invasive surgical treatment in urology

Introduction. The laparoscopic approach has become the standard in urology due to its reduced blood loss, pain, and recovery time. However, lengthy reconstructive surgeries performed in non-physiological positions are associated with a risk of specific perioperative complications. The most significant of these are rhabdomyolysis (ischemic muscle necrosis with the risk of acute renal failure) and peripheral nerve injury (PNI). Risk factors include male gender, high BMI, surgical duration, and positions with significant table flexion. The aim of the review is to study the frequency of perioperative complications during laparoscopic and endoscopic surgeries and their prevention. Materials and methods. To assess the frequency of perioperative complications in Russian urologists' practices, an online survey of 117 responding urologists was conducted. Questions covered the types of procedures performed, complications encountered, patient positioning, and operating room equipment. A systematic literature search was also conducted in PubMed, Scholar, and eLibrary using keywords related to complications of laparoscopic surgery in urology, their treatment, and prevention. Results. The survey revealed that 76.1% of urologists encountered perioperative complications. Rhabdomyolysis was reported by 10.2% of respondents, pelvic floor syndrome of the upper and lower extremities by 51.3% and 30.8%, respectively, and compartment syndrome by 22%. Only 27.4% of respondents confirmed that their operating rooms are fully equipped with certified equipment for safe positioning. The overwhelming majority (94.9%) believe that positioning should be performed by a urologist. The article provides a detailed analysis of positioning techniques (lateral position, Trendelenburg) and their modifications aimed at reducing risks. The importance of proper placement of the axillary roll, limiting arm abduction to ≤90°, and using elastic pads and non-slip mattresses to prevent neuropathy and compression injuries is emphasized. Conclusions. Preventing perioperative complications in urological laparoscopic procedures requires a comprehensive approach and the joint efforts of the entire surgical team. Adherence to proper positioning, including correct limb positioning and the use of pressure-relieving pads, minimizes the risk of rhabdomyolysis and peripheral nerve damage. This not only improves patient safety but also preserves their quality of life and optimizes the use of healthcare resources.