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.

Results:
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%.

Conclusion:
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.