Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system

Coelho, Rafael F., Palmer, Kenneth J., Rocco, Bernardo, Moniz, Ravendra R., Chauhan, Sanket, Orvieto, Marcelo A., Coughlin, Geoff and Patel, Vipul R. (2010) Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. European Urology, 57 6: 945-952. doi:10.1016/j.eururo.2010.02.001


Author Coelho, Rafael F.
Palmer, Kenneth J.
Rocco, Bernardo
Moniz, Ravendra R.
Chauhan, Sanket
Orvieto, Marcelo A.
Coughlin, Geoff
Patel, Vipul R.
Title Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system
Journal name European Urology   Check publisher's open access policy
ISSN 0302-2838
1873-7560
Publication date 2010-06
Sub-type Article (original research)
DOI 10.1016/j.eururo.2010.02.001
Volume 57
Issue 6
Start page 945
End page 952
Total pages 8
Place of publication Basel, Switzlerland
Publisher Karger
Collection year 2011
Language eng
Formatted abstract
Background:
Perioperative complications following robotic-assisted radical prostatectomy (RARP) have been previously reported in recent series. Few studies, however, have used standardized systems to classify surgical complications, and that inconsistency has hampered accurate comparisons between different series or surgical approaches.

Objective:

To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients.

Design, setting, and participants:
We analyzed 2500 patients who underwent RARP for treatment of clinically localized prostate cancer (PCa) from August 2002 to February 2009. Data were prospectively collected in a customized database and retrospectively analyzed. Intervention: All patients underwent RARP performed by a single surgeon.

Measurements:
The data were collected prospectively in a customized database. Complications were classified using the Clavien grading system. To evaluate trends regarding complications and radiologic anastomotic leaks, we compared eight groups of 300 patients each, categorized according the surgeon's experience (number of cases).

Results and limitations:
Our median operative time was 90 min (interquartile range [IQR]: 75-100 min). The median estimated blood loss was 100 ml (IQR:100-150 ml). Our conversion rate was 0.08%, comprising two procedures converted to standard laparoscopy due to robot malfunction. One hundred and forty complications were observed in 127 patients (5.08%). The following percentages of patients presented graded complications: grade 1, 2.24%; grade 2, 1.8%; grade 3a, 0.08%; grade 3b, 0.48%; grade 4a, 0.40%. There were no cases of multiple organ dysfunction or death (grades 4b and 5). There were significant decreases in the overall complication rates (p = 0.0034) and in the number of anastomotic leaks (p < 0.001) as the surgeon's experience increased.

Conclusions:

RARP is a safe option for treatment of clinically localized PCa, presenting low complication rates in experienced hands. Although the robotic system provides the surgeon with enhanced vision and dexterity, proficiency is only accomplished with consistent surgical volume; complication rates demonstrated a tendency to decrease as the surgeon's experience increased. © 2010 European Association of Urology.
Keyword Complications
Prostatectomy
Prostatic neoplasm
Robotics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ
Additional Notes Available online 13 February, 2010.

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Non HERDC
 
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Created: Fri, 18 Feb 2011, 09:41:11 EST by Caroline Irle on behalf of UQ Centre for Clinical Research