title: Management of rectal injury during robotic radical prostatectomy.
abstract: OBJECTIVE
  To review the incidence and management of rectal injury in 4400 consecutive cases of robotic radical prostatectomy at a single institution.
  
  
  METHODS
  From September 2001 to September 2009, 4400 patients underwent robotic radical prostatectomy. We reviewed the intraoperative and postoperative data from patients with rectal injuries. Once recognized, the rectal injuries were closed in 2 layers. Clear liquids were started the day after surgery. Healing of the vesicourethral anastomosis was confirmed by cystography 5-14 days postoperatively.
  
  
  RESULTS
  Rectal injuries were identified in 10 patients (0.2%). The mean patient age was 58.6 years (range 44-68), and the mean body mass index was 25.8 kg/m(2) (range 22-29). The mean prostate-specific antigen level was 7.1 ng/mL (range 0.9-14.8), and the mean prostate weight was 58.9 g (range 22-102). The clinical stage was T1c, T2a, and T2c in 7, 2, and 1 patient, respectively. The preoperative Gleason score was 6, 7, and 8 in 3, 3, and 4 patients, respectively. All rectal injuries were diagnosed and repaired intraoperatively. Of the 10 patients, 9 had an uneventful postoperative course. The average urethral catheterization time for these patients was 14 days (range 6-21). One patient had gross fecal spillage and developed a rectourethral fistula requiring a delayed diverting colostomy. No perioperative mortality occurred.
  
  
  CONCLUSIONS
  We found a low incidence of rectal injury during robotic radical prostatectomy. We have also demonstrated that rectal injuries can be managed primarily with meticulous closure with minimal morbidity.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Henry Ford Hospital, Detroit, MI48202, USA. ekheter1@hfhs.org
authors.forename: Emil
authors.initials: E
authors.lastname: Kheterpal
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: Sameer
authors.initials: S
authors.lastname: Siddiqui
authors.forename: Naveen
authors.initials: N
authors.lastname: Pokala
authors.forename: James
authors.initials: J
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000293:injuries*; D012189:Retrospective Studies; D012371:Robotics; D014521:Urethra / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery