René J Sotelo1, Alexander Haese2, Victor Machuca3, Luis Medina3, Luciano Nuñez3, Flavio Santinelli4, Andrés Hernandez5, Ali Riza Kural6, Alexander Mottrie7, Camilo Giedelman8, Mariano Mirandolino9, Kenneth Palmer10, Ronney Abaza11, Reza Ghavamian12, Arieh Shalhav13, Alireza Moinzadeh14, Vipul Patel10, Michael Stifelman15, Ingolf Tuerk16, David Canes14. 1. Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA. Electronic address: renesotelo@mac.com. 2. Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany. 3. Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela. 4. Hospital Evita Pueblo, Buenos Aires, Argentina. 5. Hope Urology Center, Mexico. 6. Acibadem Maslak Hospital, Sarıyer, Turkey. 7. OVL Hospital, Aalst, Belgium. 8. Marly Clinic, Bogota, Colombia. 9. Centro Clinico Mae de Deus, Porto Alegre, Brazil. 10. Global Robotics Institute, Celebration, FL, USA. 11. Ohio State University Wexner Medical Center, Columbus, OH, USA. 12. Montefiori Medical Center, Bronx, NY, USA. 13. Duchossois Center for Advanced Medicine, Chicago, IL, USA. 14. Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA. 15. New York University Langone Medical Center, New York, NY, USA. 16. St. Elizabeth's Medical Center, Brighton, MA, USA.
Abstract
BACKGROUND: The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE: We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS: Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE: Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS: As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS: Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY: Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
BACKGROUND: The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE: We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS: Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE: Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS: As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS: Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY: Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
Authors: Rafael Rocha Tourinho-Barbosa; Marcos Tobias-Machado; Adalberto Castro-Alfaro; Gabriel Ogaya-Pinies; Xavier Cathelineau; Rafael Sanchez-Salas Journal: Arab J Urol Date: 2017-12-14