Skip to main content
SpringerLink
Log in

Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

A robot-assisted laparoscopic approach for radical prostatectomy (RALRP) is being adopted increasingly worldwide for the treatment of localized prostate cancer (CaP). Complications assessment is essential to the objective evaluation of any new procedure. This study aimed to assess the perioperative complications encountered during the implementation of a robot-assisted urologic surgery program.

Methods

A prospective data collection for all men with a diagnosis of CaP who underwent RALRP between 2005 and 2009 in our department was achieved. Together with perioperative data, all the perioperative complications encountered were specifically recorded, including robot dysfunctions. The RALRP was performed with the three-arm Da Vinci system using a transperitoneal approach with six ports. To assess the perioperative complications, the validated Clavien–Dindo classification of surgical procedures was used. Two surgeons were involved in these procedures. A modified Clavien–Dindo classification also was used to account for intraoperative complications.

Results

According to the Clavien–Dindo classification, 16 complications (6.7% complication rate) were recorded during the first 240 procedures. Besides postoperative complications, five procedures (2.1%) were directly affected by robot malfunctions without notable consequences for the patients. Considering these five additional complications, an 8.8% complication rate was recorded using a modified Clavien–Dindo classification. The main limitation of the study was its design restricted to RALRP procedures alone. The second limitation was that the authors’ modified classification needs to be validated with a larger series and for different surgical procedures.

Conclusions

The findings show that RALRP is a safe alternative to classical surgery and that the robotic approach is reliable. The authors believe that the reliability of technological devices should be systematically discussed when outcome analysis of a new procedure is performed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics, 2009. CA Cancer J Clin 59:225–249

    Article  PubMed  Google Scholar 

  2. Binder J, Kramer W (2001) Robotically assisted laparoscopic radical prostatectomy. BJU Int 87:408–410

    Article  CAS  PubMed  Google Scholar 

  3. Lepor H (2009) Status of radical prostatectomy in 2009: is there medical evidence to justify the robotic approach? Rev Urol 11:61–70

    PubMed  Google Scholar 

  4. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, Patel V, Rassweiler J, Van Poppel H (2009) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol 55:1037–1063

    Article  PubMed  Google Scholar 

  5. Costello AJ, Haxhimolla H, Crowe H, Peters JS (2005) Installation of telerobotic surgery and initial experience with telerobotic radical prostatectomy. BJU Int 96:34–38

    Article  PubMed  Google Scholar 

  6. Patel VR, Thaly R, Shah K (2007) Robotic radical prostatectomy: outcomes of 500 cases. BJU Int 99:1109–1112

    Article  PubMed  Google Scholar 

  7. Drouin SJ, Vaessen C, Hupertan V, Comperat E, Misrai V, Haertig A, Bitker MO, Chartier-Kastler E, Richard F, Roupret M (2009) Comparison of midterm carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol 27:599–605

    Article  PubMed  Google Scholar 

  8. Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC, Keating NL (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302:1557–1564

    Article  CAS  PubMed  Google Scholar 

  9. Hu JC, Nelson RA, Wilson TG, Kawachi MH, Ramin SA, Lau C, Crocitto LE (2006) Perioperative complications of laparoscopic and robotic assisted laparoscopic radical prostatectomy. J Urol 175:541–546

    Article  PubMed  Google Scholar 

  10. Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M (2005) Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174:915–918

    Article  PubMed  Google Scholar 

  11. Rabbani F, Yunis LH, Pinochet R, Nogueira L, Vora KC, Eastham JA, Guillonneau B, Laudone V, Scardino PT, Touijer K (2009) Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol. doi:10.1016/j.eururo.2009.11.034

  12. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    CAS  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  14. Constantinides CA, Tyritzis SI, Skolarikos A, Liatsikos E, Zervas A, Deliveliotis C (2009) Short- and long-term complications of open radical prostatectomy according to the Clavien classification system. BJU Int 103:336–340

    Article  PubMed  Google Scholar 

  15. Novara G, Ficarra V, D’Elia C, Secco S, Cavalleri S, Artibani W (2009) Prospective evaluation with standardised criteria for postoperative complications after robotic-assisted laparoscopic radical prostatectomy. Eur Urol. doi:10.1016/j.eururo.2009.11.032

  16. Touijer K, Guillonneau B (2006) Laparoscopic radical prostatectomy: a critical analysis of surgical quality. Eur Urol 49:625–632

    Article  PubMed  Google Scholar 

  17. Martin RC II, Brennan MF, Jaques DP (2002) Quality of complication reporting in the surgical literature. Ann Surg 235:803–813

    Article  PubMed  Google Scholar 

  18. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  19. Rozet F, Jaffe J, Braud G, Harmon J, Cathelineau X, Barret E, Vallancien G (2007) A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience. J Urol 178:478–482

    Article  PubMed  Google Scholar 

  20. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW (2004) Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology 63:819–822

    Article  PubMed  Google Scholar 

  21. Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2,766 procedures. Cancer 110:1951–1958

    Article  PubMed  Google Scholar 

  22. Joseph JV, Rosenbaum R, Madeb R, Erturk E, Patel HR (2006) Robotic extraperitoneal radical prostatectomy: an alternative approach. J Urol 175:945–951

    Article  CAS  PubMed  Google Scholar 

  23. Sokol DK, Wilson J (2008) What is a surgical complication? World J Surg 32:942–944

    Article  PubMed  Google Scholar 

  24. Lavery HJ, Thaly R, Albala D, Ahlering T, Shalhav A, Lee D, Fagin R, Wiklund P, Dasgupta P, Costello AJ, Tewari A, Coughlin G, Patel VR (2008) Robotic equipment malfunction during robotic prostatectomy: a multi-institutional study. J Endourol 22:2165–2168

    Article  PubMed  Google Scholar 

  25. Zorn KC, Gofrit ON, Orvieto MA, Mikhail AA, Galocy RM, Shalhav AL, Zagaja GP (2007) Da Vinci robot error and failure rates: single-institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies. J Endourol 21:1341–1344

    Article  PubMed  Google Scholar 

  26. Borden LS Jr, Kozlowski PM, Porter CR, Corman JM (2007) Mechanical failure rate of Da Vinci robotic system. Can J Urol 14:3499–3501

    PubMed  Google Scholar 

  27. Jaffe J, Castellucci S, Cathelineau X, Harmon J, Rozet F, Barret E et al (2009) Robot-assisted laparoscopic prostatectomy: a single institution’s learning curve. Urology 73:127–133

    Article  PubMed  Google Scholar 

  28. Ahlering TE, Skarecky D, Lee D, Clayman RV (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741

    Article  PubMed  Google Scholar 

Download references

Disclosures

Thierry Lebeau received a grant from Intuitive Surgical, Inc. to support his work and his stay in France at the academic urology unit of La Pitié Salpétrière, University Paris VI. Christophe Vaessen has been enrolled occasionally as a consultant by Intuitive Surgical, Inc. Morgan Rouprêt, Karim Ferhi, Emmanuel Chartier-Kastler, François Richard, and Marc-Olivier Bitker have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Urology, Pitié-Salpétrière Hospital, GHU Est, Assistance-Publique Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, 47-83 bvd de l’hopital, 75013, Paris, France

    Thierry Lebeau, Morgan Rouprêt, Karim Ferhi, Emmanuel Chartier-Kastler, François Richard, Marc-Olivier Bitker & Christophe Vaessen

  2. CeRePP Group, “Centre d’Etudes et de Recherche sur les Pathologies Prostatiques”, Paris, France

    Morgan Rouprêt

Authors
  1. Thierry Lebeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morgan Rouprêt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karim Ferhi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanuel Chartier-Kastler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. François Richard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc-Olivier Bitker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christophe Vaessen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Morgan Rouprêt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lebeau, T., Rouprêt, M., Ferhi, K. et al. Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy. Surg Endosc 25, 536–542 (2011). https://doi.org/10.1007/s00464-010-1210-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1210-z

Keywords

Search

Navigation