title: Robotic urological surgery in patients with prior abdominal operations is not associated with increased complications.
abstract: BACKGROUND
  The da Vinci Surgical Robotic System is being increasingly used to perform complex urological operations by minimally invasive techniques. Prior abdominal surgery associated with intra-abdominal adhesions may complicate robotic surgery.
  
  
  METHODS
  We used a cohort of consecutive 49 patients undergoing a variety of robotic urological procedures at our institution to study the impact of prior abdominal operations on early perioperative complications.
  
  
  RESULTS
  A total of 21/49 (43%) patients (Group A) had no history of prior abdominal surgery and the rest 28/49 (57%; Group B) had undergone prior abdominal surgery. The incidence of peritoneal adhesions was significantly higher in patients with prior abdominal surgery compared to the rest of the cohort, 54% versus 10% (P=0.002). The median operative time, estimated blood loss, postoperative drop in hemoglobin, time to hospital discharge, postoperative narcotic analgesic use and postoperative complication rate between group A and group B were not statistically different. The overall perioperative complication rate for the entire cohort was 14.3%, with 6-8% of complications occurring in each of the two groups (P=1.0). Comparative subset analysis of 28 patients in Group B, 15 (54%) and 13 (46%) with or without intra-abdominal adhesions did not reveal a significant difference in perioperative complication rates either. However, operative time was longer in patients with intra-abdominal adhesions compared to patients without, median of 590 (281-922) and 434 (153-723) min respectively, although not statistically significant (P=0.059).
  
  
  CONCLUSIONS
  Our study demonstrates that robotic urological surgery can be performed in patients with prior abdominal surgery without increased perioperative complications.
authors.affiliation: University of Nebraska Medical Center, Department of Surgery, Division of Urological Surgery, Omaha, Nebraska 68198-2360, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Nazemi
authors.forename: Anton
authors.initials: A
authors.lastname: Galich
authors.forename: Lynette
authors.initials: L
authors.lastname: Smith
authors.forename: K C
authors.initials: KC
authors.lastname: Balaji
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012371:Robotics; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*