Pleurotomy, pneumothorax, and surveillance during living donor nephroureterectomy

Objectives. To determine the incidence of and risk factors associated with pneumothorax after donor nephroureterectomy and to determine the utility of postoperative chest roentgenography. Methods. A retrospective review was made of 130 living donor nephroureterectomies performed at one institution (Yale-New Haven Hospital) using an extraperitoneal flank incision. Results. Incidental pleurotomy occurred in 11 cases (8.5%). Rib resection was associated with pleurotomy. Patient age, sex, and side of operation were not associated with pleurotomy. Ten (91%) of the 11 cases were identified intraoperatively. One unrecognized pneumothorax was identified postoperatively with chest roentgenography; no specific intervention was necessary. Conclusions. The extraperitoneal flank incision poses a significant risk for pneumothorax. Most pneumothoraces will be recognized intraoperatively. No adverse effects were noted secondary to pneumothorax.