Complications of robotic assisted radical prostatectomy

Robotic radical prostatectomy claims optimal oncologic results, minimal morbidity and best outcomes of urinary continence and erection function. Potential benefits concerning side effects and complications compared to open radical prostatectomy are analysed.

Out of 450 robotic radical prostatectomies performed, the last 210 patients aged 64 (41-78), PSA of 7.2 ng/ml (0.6-75) and body mass index of 27 (20-37) were assessed in detail using the Clavien's classification of surgical complications. In addition, a retrospective Medline based meta-analysis of 4,928 patients from eight centres involved was performed and compared to published data of open retropubic radical prostatectomy.

In total 55/210 (26%) of the patients had complications, whereof 48/55 (87%) were minor (Clavien's grade I-IIIa). Complications (IIIb and IVa) with open reoperations occurred in 7/210 (3%) of the patients including three bleedings, two incarcerated small bowels, one perforation of a sigmoid diverticle and one trocar hernia. No IVb or V complication occurred. Overall robotic complication rate is very low and appears to be even less than in open series. Minor and major complications seem to decrease after 200 individual console surgeries.

Robotic radical prostatectomy has proven to be a safe and reproducible surgical treatment with low morbidity. We encourage further trials using the same classification of complications to evaluate the morbidity of robotic prostatectomy conclusively in the near future.