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

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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.


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.


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.


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.

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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.

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Correspondence to Morgan Rouprêt.

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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).

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