A BLINDED PROSPECTIVE REPORT OF COMPLICATIONS ASSOCIATED WITH ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: We prospectively analyzed and classified our single institution experience with the perioperative complications associated with robot assisted laparoscopic radical prostatectomy (RALRP). METHODS: A total of 239 patients with a mean age of 60.6 ± 0.5 years were evaluated (1/2007 to 6/2008). Data was collected through an IRB approved blinded prospective database by an independent third party committee. The data-points accrued were set forth by a 5 member panel including 3 robotic urologic surgeons (JR,GH,GP), the chief of general surgery (HS), and a member of the hospital’s outcomes committee. The panel reviewed the Medline database from 2002 to 2008 using the terms complications and RALRP. The panel adhered to strict criteria, and formulated an extensive complications data extraction form. The Clavien system was utilized to grade complications, with grade I and II representing minor and grade III, IV, and V major complications. RESULTS: Of our 239 patients, 198 (82.8%) had an uneventful postoperative course, defined as discharged home from the hospital within 2 days postoperatively with no unscheduled office/ER visits or defined complications. Upon review of the remaining 41 patients, there were a total of 55 complications. Of these 24 (43.7%) were grade I, 17 (30.9%) grade II, 7 (12.7%) grade IIIa, 5 (9.1%) grade IIIb, 1 (1.8%) grade IVa, and 1 (1.8%) grade V complications (see TABLE). There was 1 perioperative mortality attributed to a pulmonary embolism on autopsy. Blood loss data revealed 1 (0.4%) intraoperative transfusion and 9 (3.8%) postoperative transfusions. Mean operative time was 231.9 ± 4 minutes and mean prostate volume was 40.4 ± 1.3 mL. CONCLUSIONS: RALRP is associated with major and minor complication rates of 5.44% and 14.23%, respectively. Prospective and blinded data on complications associated with RALRP are lacking in the literature. Complications in the early experience with RALRP are likely under-reported but remain in line with the early experience with open prostatectomy. Our prospective, blinded data provides an important tool to help counsel patients on complications associated with RALRP. Complications of RALRP