Perioperative Complications of Robot-Assisted Laparoscopic Radical Prostatectomy, an Unbiased Prospective Report
Michael S. Lasser, MD, Joseph F. Renzulli, MD, George F. Haleblian, MD, Harry C. Sax, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.
We prospectively analyzed and classified our single institution experience with the perioperative complications associated with robot assisted laparoscopic radical prostatectomy (RALRP) from the inception of our robotic surgical program.
A total of 322 patients with a mean age of 60.4 (43-74) years were evaluated (1/2007 to 1/2009). Data was collected through an IRB approved blinded prospective database by an independent third party committee separate from the robotic surgeons and house staff. The data-points accrued were set forth by a 5 member panel including 3 robotic urologic surgeons (JR,GH,GP), the chief of general surgery (HS), and a member of the hospital’s outcomes committee. The Modified Clavien system was utilized to grade complications, with grade I and II representing minor and grade III, IV, and V major complications.
Of our 322 patients, 266 (82.6%) 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 56 patients, there were a total of 73 complications. Of these 36 (49.3%) were grade I, 22 (30.1%) grade II, 7 (9.6%) grade IIIa, 6 (8.2%) grade IIIb, 1 (1.4%) grade IVa, and 1 (1.4%) grade V complications. There was 1 perioperative mortality attributed to a pulmonary embolism on autopsy. Blood loss data revealed 1 (0.3%) intraoperative transfusion and 10 (3.1%) postoperative transfusions. Mean operative time was 228.1 (125-537) minutes and mean prostate volume was 40.9 (14-130) mL.
RALRP is associated with major and minor complication rates of 4.0% and 15.2%, respectively. Prospective and blinded data on complications associated with RALRP are lacking in the literature. Our prospective, blinded data provides an important tool to help counsel patients on complications associated with RALRP.