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Updated: May 28, 2026
Retzius-Sparing Robot-Assisted Radical Prostatectomy
Published on: May 19, 2022
Bowel complication during robotic-assisted laparoscopic radical prostatectomy
Chi-Feng Hung1, Cheng-Kuang Yang, Chen-Li Cheng
1Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
Background:
Bowel injury is a devastating complication of radical prostatectomy. The incidence and management of bowel injury occurring during robot-assisted laparoscopic radical prostatectomy (RALP) performed at our institution was reviewed.
Patients And Methods:
Only three (1.04%) out of 288 RALPs performed at our institution between December 2005 and May 2011 were complicated by bowel injury. The mean patient age was 71 years (range 67 to 79) and mean prostate specific antigen was 19.6 ng/ml (range 6.4 to 30.6). All three patients had received transurethral resection of prostate (TURP) before RALP. Clinical stages were T1b, T1c, T2c, respectively. The mean preoperative Gleason score was 6.7 (range 6 to 7). The mean operative time was 201 minutes (range 170 to 240).
Results:
Two of the intraoperative injuries were diagnosed and repaired intraoperatively and one was diagnosed postoperatively. In the two cases of intraoperative diagnosis and repair, one patient healed primarily without colostomy and a recto-urinary fistula was evidenced by pneumaturia in the other. That patient underwent a failed fistula repair and required colostomy. The patient with unrecognized bowel injury presented with atypical acute abdomen and required laparotomy and colostomy. No perioperative mortality occurred in these three cases.
Conclusion:
Bowel injury during RALP can be managed intraoperatively; unrecognized bowel injury may present with atypical acute abdomen and dissemination of the presentation and management of bowel injury, and modifications to avoid complications might help to produce improved outcomes in RALP.
Insights
Robot-assisted laparoscopic radical prostatectomy (RALP) has a low incidence of bowel injury. Early diagnosis and management are crucial for favorable outcomes, though unrecognized injuries can lead to complications.
Area of Science:
- Urology
- Surgical Complications
- Robotic Surgery
Background:
- Bowel injury is a severe complication following radical prostatectomy.
- Robot-assisted laparoscopic radical prostatectomy (RALP) is increasingly used for prostate cancer treatment.
- Understanding the incidence and management of bowel injury in RALP is essential.
Purpose of the Study:
- To review the incidence and management of bowel injury during robot-assisted laparoscopic radical prostatectomy (RALP) at our institution.
- To analyze the outcomes of patients experiencing bowel injury during RALP.
Main Methods:
- A retrospective review of 288 RALP procedures performed between December 2005 and May 2011.
- Analysis of patient demographics, preoperative characteristics, operative details, and injury management.
- Identification of intraoperative versus postoperative diagnosis of bowel injury.
Main Results:
- Three cases (1.04%) of bowel injury occurred during RALP.
- Two injuries were diagnosed and repaired intraoperatively; one was diagnosed postoperatively.
- Outcomes included primary healing, rectourethral fistula requiring colostomy, and laparotomy with colostomy for unrecognized injury. No perioperative mortality was observed.
Conclusions:
- Bowel injury during RALP is infrequent but can be managed effectively with intraoperative diagnosis and repair.
- Unrecognized bowel injury may present with atypical acute abdomen, necessitating prompt surgical intervention.
- Modifications in surgical technique and vigilance for early detection can improve outcomes in RALP.
