Assessing the complications of laparoscopic robot-assisted surgery: the case of radical prostatectomy.
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.
Lebeau
Thierry
T
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.
Rouprêt
Morgan
M
Ferhi
Karim
K
Chartier-Kastler
Emmanuel
E
Richard
François
F
Bitker
Marc-Olivier
MO
Vaessen
Christophe
C
D000368:Aged; D015331:Cohort Studies; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome