Preventing perioperative complications of robotic-assisted radical prostatectomy

Objective: To report the change in complication rates after the identification and modification of technique to reduce their incidence during robot-assisted radical prostatectomy (RARP). Methods: This study retrospectively reviewed 1000 consecutive patients who underwent RARP from June 2002 to June 2011. A number of technical changes were made after complications were noted and changes in technique were documented. The Fisher exact test and multivariate analysis were used for comparison of techniques, and values of P <.05 were considered significant. Results: The overall rate of major and minor complications was 10.8% (108 of 1000). The complication rates of lymphoceles (0.4%), ileus (0.4%), and wound infection (0.4%) were low and did not require technical changes. There were no significant changes in rates of femoral nerve palsies, rectal injuries, or bladder neck contractures. There was statistically significant change in corneal abrasions (P =.03), fossa navicularis strictures (P =.03), and camera-site hernias (P <.001) after a directed intervention adjusted for age, body mass index, and learning curve. Clavien 3 and 4 complications all significantly decreased to ≤0.6%, with the most occurring in the first 200 cases. Conclusion: Identification and correction of perioperative complications in patients undergoing robotic prostatectomy has decreased the incidence of major and minor complications adjusted for learning curve. The conscientious monitoring of adverse events can provide targeted change in technique to decrease complications and provide information to those early in learning robotic-assisted radical prostatectomy.