Complications and incidences in our first 250 robotic radical prostatectomies

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ObjectiveTo review the incidence of and to analyze the factors possibly contributing to perioperative complications in patients undergoing robotic radical prostatectomy in our experience of 250 procedures. Materials and methodsAn analytical, descriptive, retrospective study was conducted of 250 consecutive patients who underwent robotic radical prostatectomy during a period of three years and two months (January 2006-March 2009). Data recorded included age, preoperative Gleason grade and PSA, and prostate volume. All procedures were performed by three surgeons through a transperitoneal laparoscopic approach using a four-arm daVinci robotic system. Microsoft Excel support was used. Surgical variables recorded included setup time, console operating time, bleeding volume, transfusion rate, mean hospital stay, and urethral catheterization time. Incidences and intraoperative and postoperative early and late complications occurring in these patients were reviewed. ResultsDemographic data recorded included: mean age, 61.5 years (47–74); mean preoperative PSA, 8.18ng/mL (2.6–34); mean Gleason grade, 6.8 (2–9); and mean prostate volume 34.9mL (12–124). Surgical variables recorded included: console setup time, 10.8min (6–47): console operating time, 125min (90–315); mean bleeding, 150mL (50–1150); and a 3.6% (9/250) transfusion rate. There was no perioperative mortality, and no conversion to open or laparoscopic surgery was required. Ninety-six percent of patients (240/250) had an adequate postoperative course, with a mean hospital stay of 4.2 days (3–35) and urinary catheter removal after 8 (5–28) days. Overall complication rate was 10.6%, with major complications, consisting of five surgical and three medical complications, occurring in only 3.2% of patients (8/250). Repeat surgery was required in 1.6% of cases (4/250) for late peritonitis due to cecal perforation, bleeding from epigastric artery, perineal percutaneous drainage of retrovesical hematoma, and pelvic urinoma following accidental bladder catheter dislodgment. One patient required selective arterial embolization for persistent late hematuria due to vesical artery fistula. Medical complications included acute renal failure due to thrombotic purpura resolved with hemodialysis in one patient and late pulmonary embolism managed with anticoagulation in two patients. Robot malfunction with no surgical implications or need for conversion to open surgery occurred in four patients (1.6%). Surgical maneuvers required to resolve late complications included oneumbilical hernia repair, one meatotomy for meatal stenosis, one bladder neck endoscopic incision after contracture, and one endoscopic removal of Hem-o-lok and vascular clip following erosion-migration into the bladder. ConclusionsRobotic radical prostatectomy is a safe and reproducible procedure with optimal functional and oncological results, a shorter learning curve, greater comfort and vision for surgeons, and a complication rate similar to and even better than reported for open and laparoscopic surgery series. Complications decrease with the learning curve, but surgical team experience continues to be the key factor to achieve better results.