Skip to main content
Top
Published in: World Journal of Urology 6/2008

01-12-2008 | Topic Paper

Complications of robotic assisted radical prostatectomy

Authors: Boris Fischer, Nadja Engel, Jean-Luc Fehr, Hubert John

Published in: World Journal of Urology | Issue 6/2008

Login to get access

Abstract

Objectives

Robotic radical prostatectomy claims optimal oncologic results, minimal morbidity and best outcomes of urinary continence and erection function. Potential benefits concerning side effects and complications compared to open radical prostatectomy are analysed.

Methods

Out of 450 robotic radical prostatectomies performed, the last 210 patients aged 64 (41–78), PSA of 7.2 ng/ml (0.6–75) and body mass index of 27 (20–37) were assessed in detail using the Clavien’s classification of surgical complications. In addition, a retrospective Medline based meta-analysis of 4,928 patients from eight centres involved was performed and compared to published data of open retropubic radical prostatectomy.

Results

In total 55/210 (26%) of the patients had complications, whereof 48/55 (87%) were minor (Clavien’s grade I–IIIa). Complications (IIIb and IVa) with open reoperations occured in 7/210 (3%) of the patients including three bleedings, two incarcerated small bowels, one perforation of a sigmoid diverticle and one trocar hernia. No IVb or V complication occured. Overall robotic complication rate is very low and appears to be even less than in open series. Minor and major complications seem to decrease after 200 individual console surgeries.

Conclusions

Robotic radical prostatectomy has proven to be a safe and reproducible surgical treatment with low morbidity. We encourage further trials using the same classification of complications to evaluate the morbidity of robotic prostatectomy conclusively in the near future.
Literature
1.
go back to reference Catalona WJ, Carvalhal GF, Mager DE, Smith DS (1999) Potency, continence and complication rates in 1, 870 consecutive radical retropubic prostatectomies. J Urol 162:433–438PubMedCrossRef Catalona WJ, Carvalhal GF, Mager DE, Smith DS (1999) Potency, continence and complication rates in 1, 870 consecutive radical retropubic prostatectomies. J Urol 162:433–438PubMedCrossRef
2.
go back to reference Graefen M, Walz J, Huland H (2006) Open retropubic nerve-sparing radical prostatectomy. Eur Urol 49:38–48PubMedCrossRef Graefen M, Walz J, Huland H (2006) Open retropubic nerve-sparing radical prostatectomy. Eur Urol 49:38–48PubMedCrossRef
3.
go back to reference Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958PubMedCrossRef Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958PubMedCrossRef
4.
5.
go back to reference Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO (2007) Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol 51:648–657 discussion 657–658PubMedCrossRef Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M, Peabody JO (2007) Vattikuti Institute prostatectomy: contemporary technique and analysis of results. Eur Urol 51:648–657 discussion 657–658PubMedCrossRef
6.
go back to reference Patel VR, Thaly R, Shah K (2007) Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 99:1109–1112PubMedCrossRef Patel VR, Thaly R, Shah K (2007) Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 99:1109–1112PubMedCrossRef
7.
go back to reference Zorn KC, Orvieto MA, Gong EM, Mikhail AA, Gofrit ON, Zagaja GP, Shalhav AL (2007) Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol 21:441–447PubMedCrossRef Zorn KC, Orvieto MA, Gong EM, Mikhail AA, Gofrit ON, Zagaja GP, Shalhav AL (2007) Robotic radical prostatectomy learning curve of a fellowship-trained laparoscopic surgeon. J Endourol 21:441–447PubMedCrossRef
8.
go back to reference Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRef
9.
go back to reference Ahlering TE, Patel V, Lee DI, Skarecky DW (2006) Multiinstitutional review of complications after robot-assisted laparoscopic prostatectomy (RLP). J Endourol 20:VP8–VP11CrossRef Ahlering TE, Patel V, Lee DI, Skarecky DW (2006) Multiinstitutional review of complications after robot-assisted laparoscopic prostatectomy (RLP). J Endourol 20:VP8–VP11CrossRef
10.
go back to reference Hu JC, Nelson RA, Wilson TG, Kawachi MH, Ramin SA, Lau C, Crocitto LE (2006) Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol 175:541–546 discussion 546PubMedCrossRef Hu JC, Nelson RA, Wilson TG, Kawachi MH, Ramin SA, Lau C, Crocitto LE (2006) Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol 175:541–546 discussion 546PubMedCrossRef
11.
go back to reference Andonian S, Okeke Z, Deidre A, Rastinehad A, VanderBrink BA, Richstone L, Lee BR (2008) Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDAMAUDE database. Can J Urol 15:3912–3916PubMed Andonian S, Okeke Z, Deidre A, Rastinehad A, VanderBrink BA, Richstone L, Lee BR (2008) Device failures associated with patient injuries during robot-assisted laparoscopic surgeries: a comprehensive review of FDAMAUDE database. Can J Urol 15:3912–3916PubMed
12.
go back to reference Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification on complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526PubMed Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification on complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526PubMed
13.
go back to reference John H (2008) Robotic radical prostatectomy: extraperitoneal approach. In: John H, Wiklund P (eds) Robotic urology. Springer, Heidelberg, pp 19–28CrossRef John H (2008) Robotic radical prostatectomy: extraperitoneal approach. In: John H, Wiklund P (eds) Robotic urology. Springer, Heidelberg, pp 19–28CrossRef
14.
go back to reference John H, Gettman MT (2007) Extraperitoneal robotic radical prostatectomy: operative technique—step by step. In: Stolzenburg J-U (ed) Endoscopic radical prostatectomy. Springer, Heidelberg, pp 144–159 John H, Gettman MT (2007) Extraperitoneal robotic radical prostatectomy: operative technique—step by step. In: Stolzenburg J-U (ed) Endoscopic radical prostatectomy. Springer, Heidelberg, pp 144–159
15.
go back to reference Borden LS Jr, Kozlowski PM, Porter CR, Corman JM (2007) Mechanical failure rate of da Vinci robotic system. Can J Urol 14:3499–3501PubMed Borden LS Jr, Kozlowski PM, Porter CR, Corman JM (2007) Mechanical failure rate of da Vinci robotic system. Can J Urol 14:3499–3501PubMed
16.
go back to reference Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, Zagaja GP (2007) Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol 21:1341–1344PubMedCrossRef Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, Zagaja GP (2007) Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol 21:1341–1344PubMedCrossRef
17.
go back to reference Dillioglugil O, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT (1997) Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 157:1760–1767PubMedCrossRef Dillioglugil O, Leibman BD, Leibman NS, Kattan MW, Rosas AL, Scardino PT (1997) Risk factors for complications and morbidity after radical retropubic prostatectomy. J Urol 157:1760–1767PubMedCrossRef
18.
go back to reference Hisasue S, Takahashi A, Kato R, Shimizu T, Masumori N, Itoh N, Tsukamoto T (2004) Early and late complications of radical retropubic prostatectomy: experience in a single institution. Jpn J Clin Oncol 34:274–279PubMedCrossRef Hisasue S, Takahashi A, Kato R, Shimizu T, Masumori N, Itoh N, Tsukamoto T (2004) Early and late complications of radical retropubic prostatectomy: experience in a single institution. Jpn J Clin Oncol 34:274–279PubMedCrossRef
19.
go back to reference Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, Huland H (2003) Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 43:113–118PubMedCrossRef Augustin H, Hammerer P, Graefen M, Palisaar J, Noldus J, Fernandez S, Huland H (2003) Intraoperative and perioperative morbidity of contemporary radical retropubic prostatectomy in a consecutive series of 1243 patients: results of a single center between 1999 and 2002. Eur Urol 43:113–118PubMedCrossRef
20.
go back to reference Klevecka V, Burmester L, Musch M, Roggenbuck U, Kroepfl D (2007) Intraoperative and early postoperative complications of radical retropubic prostatectomy. Urol Int 79:217–225PubMedCrossRef Klevecka V, Burmester L, Musch M, Roggenbuck U, Kroepfl D (2007) Intraoperative and early postoperative complications of radical retropubic prostatectomy. Urol Int 79:217–225PubMedCrossRef
21.
go back to reference Lepor H, Nieder AM, Ferrandino MN (2001) Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1, 000 cases. J Urol 166:1729–1733PubMedCrossRef Lepor H, Nieder AM, Ferrandino MN (2001) Intraoperative and postoperative complications of radical retropubic prostatectomy in a consecutive series of 1, 000 cases. J Urol 166:1729–1733PubMedCrossRef
22.
go back to reference John H, Schmid DM, Fehr JL (2007) Prostatectomia radical extraperitoneal Da Vinci. Actas Urol Esp 31:580–586PubMedCrossRef John H, Schmid DM, Fehr JL (2007) Prostatectomia radical extraperitoneal Da Vinci. Actas Urol Esp 31:580–586PubMedCrossRef
23.
go back to reference Joseph JV, Boczko J, Goijanin D, Madeb RR, Vicente I, Erturk E, Rosenbaum RS, Patel HR (2006) Extraperitoneal robot assisted radical prostatectomy. J Urol 175:370CrossRef Joseph JV, Boczko J, Goijanin D, Madeb RR, Vicente I, Erturk E, Rosenbaum RS, Patel HR (2006) Extraperitoneal robot assisted radical prostatectomy. J Urol 175:370CrossRef
24.
go back to reference Cathelineau X, Rozet F, Vallancien G (2004) Robotic radical prostatectomy: the European experience. Urol Clin North Am 31:693–699, viii Cathelineau X, Rozet F, Vallancien G (2004) Robotic radical prostatectomy: the European experience. Urol Clin North Am 31:693–699, viii
25.
go back to reference Ahlering TE, Woo D, Eichel L, Lee DI, Edwards RA, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of on surgeon’s experience. Urology 63:819–822PubMedCrossRef Ahlering TE, Woo D, Eichel L, Lee DI, Edwards RA, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of on surgeon’s experience. Urology 63:819–822PubMedCrossRef
26.
go back to reference Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M (2005) Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174:915–918PubMedCrossRef Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M (2005) Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174:915–918PubMedCrossRef
27.
go back to reference Menon M, Shrivastava A, Sarle R, Hemal A, Tewari A (2003) Vattikuti Institute prostatectomy: a single-team experience of 100 cases. J Endourol 17:785–790PubMedCrossRef Menon M, Shrivastava A, Sarle R, Hemal A, Tewari A (2003) Vattikuti Institute prostatectomy: a single-team experience of 100 cases. J Endourol 17:785–790PubMedCrossRef
28.
go back to reference Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol 174:269–272PubMedCrossRef Patel VR, Tully AS, Holmes R, Lindsay J (2005) Robotic radical prostatectomy in the community setting—the learning curve and beyond: initial 200 cases. J Urol 174:269–272PubMedCrossRef
29.
go back to reference Farnham SB, Webster TM, Herrell SD, Smith JA Jr (2006) Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology 67:360–363PubMedCrossRef Farnham SB, Webster TM, Herrell SD, Smith JA Jr (2006) Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retropubic prostatectomy. Urology 67:360–363PubMedCrossRef
30.
go back to reference Zincke H, Bergstralh EJ, Blute ML, Myers RP, Barrett DM, Lieber MM, Martin SK, Oesterling JE (1994) Radical prostatectomy for clinically localized prostate cancer: long-term results of 1, 143 patients from a single institution. J Clin Oncol 12:2254–2263PubMed Zincke H, Bergstralh EJ, Blute ML, Myers RP, Barrett DM, Lieber MM, Martin SK, Oesterling JE (1994) Radical prostatectomy for clinically localized prostate cancer: long-term results of 1, 143 patients from a single institution. J Clin Oncol 12:2254–2263PubMed
31.
go back to reference El-Hakim A, Tewari A (2004) Robotic prostatectomy: a review. MedGenMed 6:20. (online) El-Hakim A, Tewari A (2004) Robotic prostatectomy: a review. MedGenMed 6:20. (online)
32.
go back to reference Mc Neill A, Wasserscheid J, Rabenalt R, Do M, Liatsikos EN, Stolzenburg JU (2008) Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and PLND by bilateral peritoneal fenestration. Eur Urol Suppl 7(3):302 Mc Neill A, Wasserscheid J, Rabenalt R, Do M, Liatsikos EN, Stolzenburg JU (2008) Reduction in incidence of lymphocele following extraperitoneal radical prostatectomy and PLND by bilateral peritoneal fenestration. Eur Urol Suppl 7(3):302
Metadata
Title
Complications of robotic assisted radical prostatectomy
Authors
Boris Fischer
Nadja Engel
Jean-Luc Fehr
Hubert John
Publication date
01-12-2008
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 6/2008
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-008-0287-7

Other articles of this Issue 6/2008

World Journal of Urology 6/2008 Go to the issue