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Updated: Sep 20, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Morbidity of laparoscopic radical prostatectomy: summary of early multi-institutional experience in Japan
Yoichi Arai1, Shin Egawa, Toshiro Terachi
1Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan. yarai@uro.med.tohoku.ac.jp
Aim:
Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi-institutional experience of the procedure in Japan.
Methods:
A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51-80).
Results:
The median operative time was 403 minutes (range, 167-925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound-related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1-5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%).
Conclusion:
Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.
Insights
Early Japanese experience with laparoscopic radical prostatectomy shows potential for reduced blood loss and faster recovery, but highlights a high complication rate. Surgeons must master skills to mitigate risks during this learning curve.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic radical prostatectomy (LRP) is an emerging surgical technique globally.
- Assessing early multi-institutional outcomes is crucial for technique adoption.
Purpose of the Study:
- To report the initial multi-institutional experience with LRP in Japan.
- To evaluate early complications and postoperative recovery following LRP.
Main Methods:
- Retrospective review of 148 patients who underwent LRP for localized prostate cancer across seven Japanese institutions.
- Analysis of early complications (within 30 days) and convalescence parameters.
Main Results:
- A 37.2% complication rate was observed, with intraoperative injuries in 16.9% of patients (e.g., rectal, bladder, intestinal).
- 10.8% of patients required conversion to open surgery.
- Shorter convalescence was noted, with median ambulation on postoperative day 1 and catheter removal by day 7 in 49.3%.
Conclusions:
- LRP offers potential benefits like reduced blood loss and faster recovery.
- High early morbidity necessitates surgeon awareness and skill development.
- Mastering laparoscopic techniques and knowledge sharing are key to improving patient outcomes and reducing the learning curve impact.
