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Updated: Jun 18, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Prospective evaluation with standardised criteria for postoperative complications after robotic-assisted laparoscopic
Giacomo Novara1, Vincenzo Ficarra, Carolina D'Elia
1Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy.
Background:
Very few studies have evaluated the risk of complications following robotic-assisted laparoscopic radical prostatectomy (RARP), and all were flawed by several methodological biases.
Objective:
To evaluate the prevalence of early complications and risk factors following RARP, reporting complications in agreement with the standardised Martin criteria.
Design, Setting, And Participants:
All 415 patients who underwent surgery for clinically localised prostate cancer from April 2005 to April 2009 at a single tertiary academic centre were prospectively studied.
Intervention:
RARP was performed by two surgeons with the same technique.
Measurements:
Complications were collected and reported according to the standardised Martin criteria.
Results And Limitations:
One hundred and two complications were observed in 90 patients (21.6%), with bleeding (5.3%), lymphorrhoea (4.3%), and pelvic haematoma (2.4%) the most common ones. According to the modified Clavien system, 41 patients (10%) had grade 1, 37 (9%) had grade 2, 11 (3%) had grade 3, and 1 (0.2%) had grade 4 complications. On multivariable analysis, prostate volume (odds ratio: 0.985; p<0.001) and the number of cases performed (p<0.001) were independent predictors of the occurrence of any grade complications. Considering grade 3 to 4 complications, only the number of cases performed by the surgeons was significantly associated with major complications in a univariable analysis (p<0.001). The major limitation of the study is represented by the relatively small number of patients and events included in the analysis, resulting in the study being underpowered to identify some factors predicting any or high-grade complications.
Conclusions:
Applying standardised criteria to collect and report complications, we identified early complications in about 22% of our patients undergoing RARP. Although most of the patients experienced minor complications, 3% of them did experience grade 3 or 4 complications. Prostate volume and number of RARP performed by the surgeons were independent predictors of the occurrence of complications.
Insights
Robotic-assisted laparoscopic radical prostatectomy (RARP) led to early complications in 21.6% of patients, with most being minor. Prostate size and surgeon experience were key predictors of complications following RARP.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- Limited research exists on complications after robotic-assisted laparoscopic radical prostatectomy (RARP).
- Previous studies often suffered from methodological biases.
- Standardized criteria for complication reporting are needed.
Purpose of the Study:
- To determine the prevalence of early complications after RARP.
- To identify risk factors associated with RARP complications.
- To report complications using the standardized Martin criteria.
Main Methods:
- Prospective study of 415 patients undergoing RARP for localized prostate cancer.
- Surgery performed by two experienced surgeons using a consistent technique.
- Complications meticulously recorded and classified using the Martin criteria.
Main Results:
- 21.6% of patients experienced early complications, totaling 102 events.
- Most common complications included bleeding (5.3%), lymphorrhoea (4.3%), and pelvic hematoma (2.4%).
- Prostate volume and surgeon case volume were independent predictors of overall complications.
Conclusions:
- Standardized reporting identified early complications in approximately 22% of RARP patients.
- While most complications were minor, 3% were severe (grade 3-4).
- Prostate volume and surgical experience are crucial factors influencing RARP complication rates.