Classification and trends of perioperative morbidities following laparoscopic radical prostatectomy.
OBJECTIVE
We classified and assessed trends in the incidence, severity and management of perioperative morbidity following laparoscopic radical prostatectomy (LRP).


METHODS
We retrospectively reviewed the records of 250 patients with clinically localized prostate cancer who underwent transperitoneal LRP, as performed by 2 surgeons (CPP and LMS), between April 2001 and March 2004. The Clavien classification system was used to grade complications for cases completed laparoscopically.


RESULTS
In the 246 cases completed laparoscopically 20 grade II, 12 grade III and 2 grade IV complications were noted during a mean followup of 13.7 months (overall complication rate 13.8%). Median hospital stay was 2 days (range 2 to 8) and median duration of bladder catheterization was 10 days (range 3 to 36). Postoperative ileus that prolonged hospital stay was the most frequent complication and it occurred in 8 patients (3.3%). Seven patients required blood transfusion (2.8%). Bladder neck contracture was observed in 3 patients (1.2%). A total of 11 complications occurred in the first 50 cases, while 12, 6, 8 and 1 occurred in cases 51 to 100, 101 to 150, 151 to 200 and 201 to 250, respectively.


CONCLUSIONS
Perioperative complications following LRP are mostly self-limited and grade II or III (94.1%). The incidence of complications and need for conversion to open radical prostatectomy decreased with experience. Uniform reporting and grading of surgical complications via a standardized classification system may permit more meaningful comparisons among different centers and surgical techniques.
Gonzalgo
Mark L
ML
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Pavlovich
Christian P
CP
Trock
Bruce J
BJ
Link
Richard E
RE
Sullivan
Wendy
W
Su
Li-Ming
LM
D000328:Adult; D000368:Aged; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies