Intraoperative and postoperative complications encountered in patients undergoing robotic-assisted laparoscopic radical prostatectomy. An analysis of 3000 consecutive cases

Vahudin Zugor, Sandor Poth, Andreas Eck, Jorn H. Witt, Apostolos P. Labanaris

Department of Urology and Pediatric Urology – Prostate Center Northwest, St. Antonius Medical Center, Gronau, Germany

Introduction & objectives:
The objective of this study is to assess the intraoperative and postoperative complications encountered in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) by analysing 3000 consecutive cases.

Material & Methods:
The records of N=3000 men who underwent RALP from February 2006 to August 2011 were retrospectively reviewed. All patients were assessed for intraoperative as well as postoperative complications. Postoperative complications and re-interventions encountered up to 30 days postoperatively stratified by the Clavien classification and were characterized as minor (Clavien’s grade I–IIIa) and major postoperative complications (Clavien’s grade IIIb-IVa). Hemorrhage was defined as greater than 500 ml blood loss during the operation. Further parameters analyzed included: age, body-mass index (BMI), prostate size, PSA values, biopsy Gleason score, lymph node dissection, and pathologic stage.

The intraoperative complications as well as minor and major postoperative complications are listed in the Tables. The median age of the patients was 64.1 years, median BMI was 26.7 kg/m2, median prostate weight was 40.1 gr. and median PSA value was 10.1 ng/ml. The Gleason biopsy score was Gleason <7 in 65% of cases, Gleason 7 in 34.4% and Gleason >7 in 9.6% of cases. Lymph node dissection was performed in 75.9% of cases. An organ-confined disease in was noted in 75% of cases and extraprostatic extension in 25%. The overall intraoperative complication rate was 5.1%, the overall minor postoperative complication rate was 16.1% and overall major 1.8%.

RALP is not free of complications. Nevertheless in experienced hands it can be considered as a safe surgical procedure with very low morbidity and mortality.