Preventing Complications in Robotic Prostatic Surgery

Abstract

Context The urologic community has embraced robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) as a surgical therapeutic approach to localised prostate cancer (PCa). Safety, efficacy, and potential complications of RALP should be clearly known and emphasised in order to improve outcomes. Objective To provide an overview of the prevention and reduction of complications in RALP to aid the understanding of the multivariable nature of a surgical procedure incorporating highly developed technology. Evidence acquisition The present manuscript is based on a presentation on the prevention of complications in robotic prostatic surgery held at the European Association of Urology Section of Oncological Urology meeting in Vienna, Austria, in January 2010. The scope of this article is such that no attempt has been made to include all available evidence on the topic but rather a selection based on practical considerations. Experience with RALP gained at the Institut Montsouris is also reflected in the body of the manuscript. Evidence synthesis Despite the lack of standardisation when talking about complications, RALP seems to be at least equivalent to laparoscopic radical prostatectomy, and recently, it appears to provide even better results. To prevent complications, RALP should be considered in its entirety from patient evaluation to postoperative care, not just the surgery itself. The surgeon remains the first actor, and no place is left for improvisation. Thus, every step of the procedure must be perfectly understood and mastered. One must remember that years of training stand behind these high levels of control and technique. Conclusions Prevention and management of complications in RALP require a high level of team expertise. Perfect standardisation of the procedure and the communication of the procedure's results are mandatory to lowering the incidence of complications and to facilitating its diffusion to the urologic community.