title: Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system.
abstract: BACKGROUND
  Perioperative complications following robotic-assisted radical prostatectomy (RARP) have been previously reported in recent series. Few studies, however, have used standardized systems to classify surgical complications, and that inconsistency has hampered accurate comparisons between different series or surgical approaches.
  
  
  OBJECTIVE
  To assess trends in the incidence and to classify perioperative surgical complications following RARP in 2500 consecutive patients.
  
  
  METHODS
  We analyzed 2500 patients who underwent RARP for treatment of clinically localized prostate cancer (PCa) from August 2002 to February 2009. Data were prospectively collected in a customized database and retrospectively analyzed.
  
  
  METHODS
  All patients underwent RARP performed by a single surgeon.
  
  
  METHODS
  The data were collected prospectively in a customized database. Complications were classified using the Clavien grading system. To evaluate trends regarding complications and radiologic anastomotic leaks, we compared eight groups of 300 patients each, categorized according the surgeon's experience (number of cases).
  
  
  CONCLUSIONS
  Our median operative time was 90min (interquartile range [IQR]: 75-100min). The median estimated blood loss was 100ml (IQR:100-150ml). Our conversion rate was 0.08%, comprising two procedures converted to standard laparoscopy due to robot malfunction. One hundred and forty complications were observed in 127 patients (5.08%). The following percentages of patients presented graded complications: grade 1, 2.24%; grade 2, 1.8%; grade 3a, 0.08%; grade 3b, 0.48%; grade 4a, 0.40%. There were no cases of multiple organ dysfunction or death (grades 4b and 5). There were significant decreases in the overall complication rates (p=0.0034) and in the number of anastomotic leaks (p<0.001) as the surgeon's experience increased.
  
  
  CONCLUSIONS
  RARP is a safe option for treatment of clinically localized PCa, presenting low complication rates in experienced hands. Although the robotic system provides the surgeon with enhanced vision and dexterity, proficiency is only accomplished with consistent surgical volume; complication rates demonstrated a tendency to decrease as the surgeon's experience increased.
authors.affiliation: Global Robotics Institute, Florida Hospital Celebration Health, Celebration, Florida 34747, USA.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Coelho
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Palmer
authors.forename: Bernardo
authors.initials: B
authors.lastname: Rocco
authors.forename: Ravendra R
authors.initials: RR
authors.lastname: Moniz
authors.forename: Sanket
authors.initials: S
authors.lastname: Chauhan
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Orvieto
authors.forename: Geoff
authors.initials: G
authors.lastname: Coughlin
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000368:Aged; D019985:Benchmarking / Q000379:methods*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome