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Effect of operating room time on safety and outcomes in ureteroscopy with laser lithotripsy
Introduction and Objective
Many urologists feel that prolonged operative time during ureteroscopy (URS) with laser lithotripsy is associated with an increased risk of complications. The objective of this study was to determine the effect of operating room time on safety and efficacy of flexible and rigid URS with laser lithotripsy.
Methods
Retrospective chart review was conducted on all URS cases for renal and ureteral stones performed by three surgeons at one institution from September 2010 to January 2013. Operating room (OR) time was reviewed through intraoperative and anesthesia records. Reviewed complications included urosepsis, readmission, or requirement of second procedure. The stone-free rates and complication rates were analyzed.
Results
Three hundred sixty-one cases were identified. Mean patient age was 51 years and average stone size was 9 mm. The overall stone-free rate was 96%, with no difference in stone free rate observed based on OR times. Regarding complications, in cases with OR time 0-30 minutes, 30-60 minutes, or 61-90 minutes, complication rates were respectively, 0%, 5.63%, and 4.62% (p > 0.05) with no difference in complication rates noted. However, in cases with OR time between 91-120 minutes, complication rate was increased at 15.9% (p<0.05). In cases with OR time 120 minutes or greater, complication rate was also increased at 16.7% (p < 0.05). Complication and stone free rates are summarized in Table 1.
Conclusions
In this study, there was an overall high stone free rate of URS with laser with no difference in stone free rate based on OR time. However, there was a higher rate of complications noted when total operative time exceeded 90 minutes. Thus, when URS with laser lithotripsy exceeds 90 to 120 minutes, the urologist should consider staging the procedure.
Table 1.

Operating Room Time (minutes)	Stone Free Rate	Complication Rate
0-30	8/8 (100%)	0/8 (0%)
31-60	139/142 (98%)	8/142 (5.63%)
61-90	127/130 (98%)	6/130 (4.62%)
91-120	41/44 (93%)	7/44 (15.91%)
>120	32/36 (88%)	6/36 (16.67%)