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Perioperative Complications of Robot Assisted Laparoscopic Radical Prostatectomy: The Initial 476 Cases of the Brown University Experience
Michael S. Lasser, MD, Joseph Renzulli, MD, George E. Haleblian, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.

BACKGROUND
We prospectively analyzed our single institution experience with the robot assisted laparoscopic radical prostatectomy (RALRP). The perioperative complications were identified and classified.
METHODS
A total of 476 patients with a mean age of 60.2 ± 0.3 years were evaluated (11/2006 to 1/2010). Data was assimilated through an IRB approved blinded prospective database by an independent third party committee. The data-points accrued were set forth by a 5 member panel including 3 robotic urologic surgeons (JR,GH,GP), and a member of the hospital’s outcomes committee. Data was collected prospectively both at the time of surgery, via an extensive complications data extraction form, and throughout the initial 30 days postoperatively. The Modified Clavien system was utilized to grade complications with grade I and II representing minor and grade III, IV, and V major complications.
RESULTS
Of our 476 patients, 400 (84%) had an uneventful postoperative course, defined as discharged home from the hospital within 2 days postoperatively with no unscheduled office/ER visits or defined complications. Upon review of the remaining 76 (15.9%) patients, there were a total of 97 complications. Of these 49 (50.5%) were grade I, 31 (31.9%) grade II, 7 (7.2%) grade IIIa, 8 (8.2%) grade IIIb, 1 (1.0%) grade IVa, and 2 (2.1%) grade V complications. There were 2 perioperative mortalities attributed to a pulmonary embolism and a bowel injury on autopsy. Mean operative time was 218.2 ± 2.6 minutes and mean prostate volume was 42.3 ± 1.1 mL. When our 200 most recent cases were reviewed, we found a mean operative time of 201.4 ± 3.3 min with 37 complications in 32 (16%) patients. In this most recent experience our major complication rate dropped to 1.5% from 3.1%.
CONCLUSIONS
RALRP is associated with major and minor complication rates of 3.1% and 14.3%, respectively. Prospective and blinded data on complications associated with RALRP are lacking in the literature. Complications early in a surgeons experience with RALRP are to be expected and are likely under-reported in the literature. Our prospective, blinded data provides an important tool to help counsel patients.


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