Complications of Robotic Assisted Laparoscopic Prostatectomy: Review and Assessment of Risk Factors

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Background: We analyzed our prospective database for complications and complication management in patients undergoing robotic assisted laparoscopic prostatectomy (RALP). Risk factors for complications such as age and BMI were examined.
Methods: Between January 2004 and February 2008, 1083 consecutive patients with clinically localized prostate cancer and a mean age of 59 years underwent RALP at our institution. The Clavien classification system was used to grade complications. Grade 1 defined all events that, if left untreated, would have a spontaneous resolution or needed a simple bedside intervention. Grade 2 complications required specific medication, including antibiotics and blood transfusion. Grade 3 complications necessitated surgical, endoscopic, or radiologic intervention (3a without general anesthesia, 3b under general anesthesia). Neighboring organ injuries and organ failures were classified as grade 4, and death was considered a grade 5 complication. Complication management was recorded. Chi square analysis of risk factors for complications was performed.
Results: 61 grade I, 61 grade II, 21 Grade IIIa, 65 Grade IIIb, and 7 Grade IV complications were noted during a mean followup of 12 months. 16.6% of patients had one or more complications. Median hospital stay was 2 days (range 1 to 14). Average discharge hematocrit was 35.7. Complications occurring at a rate above 0.5% were bladder neck contracture (2.4%), ileus (2.2%), delayed urine leak (1.8%), inguinal hernia (1.4%), urinary retention (1.1%), pulmonary embolus (0.9%), immediate urine leak (0.9%), DVT (0.8%), pelvic abscess (0.8%), UTI (0.7%), incisional hernia (0.6%), and transfusion or exploration for bleeding (0.6%). There was no difference in the complication rate for men younger than or older than 60 years (15.8% v. 17.7%, n.s). However, BMI (range 17.0-57.4 kg/m2) greater than 35 kg/m2 had a complication rate of 29.2% v. 15.9% for men with a BMI <35 kg/m2 (p<0.005).
Conclusions: Perioperative complications following robotic assisted laparoscopic prostatectomy compare favorably to open and laparoscopic series. Obesity but not advancing age was associated with an increased risk of surgical complications. Increasing knowledge of the degree and incidence of post-operative complications in RALP’s and reporting them in a standardized fashion will help make comparisons between centers more insightful.

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