title: Surgical complications after robot-assisted laparoscopic radical prostatectomy: the initial 1000 cases stratified by the clavien classification system.
abstract: OBJECTIVE
  Complications after robot-assisted prostatectomy are widely reported and varied. Our goal was to determine the incidence of surgical complications resulting from robot-assisted laparoscopic radical prostatectomy (RALP) during the initial phase of a new robotics program that was developed by two surgeons without laparoscopic or robotic fellowship training. A secondary goal was to see if experience changed the incidence of complications with this technology.
  
  
  METHODS
  A prospectively maintained database was used to evaluate the first 1000 consecutive patients who were treated with RALP from January 2004 to June 2009. The database was reviewed for evidence of complications in the perioperative period. All patients underwent robot-assisted laparoscopic radical prostatectomy by two surgeons. Complications were confirmed and supplemented by retrospectively reviewing the departmental morbidity and mortality reports, as well as the hospital records. The Clavien classification system, a standardized and validated scale for complication reporting, was applied to all events. The complication rate was determined per 100 patients treated and tested with logistic regression for a relationship with surgeon experience.
  
  
  RESULTS
  Ninety-seven (9.7%) patients experienced a total of 116 complications; 81 patients experienced a single complication and 16 patients experienced ≥2 complications. The majority of complications (71%) were either grade I or II. The complication rate decreased with experience when the first 500 cases were compared with the latter 500 cases (P=0.007). All the data were reviewed retrospectively. Involvement of residents/fellows increased as primary surgeon experience improved.
  
  
  CONCLUSIONS
  Complications after RALP are most commonly minor, requiring expectant or medical management only, even during the initiation of a RALP program. The complication rate improved significantly during the study period.
authors.affiliation: Department of Urology, The George Washington University Medical Center, Washington, DC 20037, USA. Faisal81@gwu.edu
authors.forename: Faisal
authors.initials: F
authors.lastname: Ahmed
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rhee
authors.forename: Douglas
authors.initials: D
authors.lastname: Sutherland
authors.forename: Compton
authors.initials: C
authors.lastname: Benjamin
authors.forename: Jason
authors.initials: J
authors.lastname: Engel
authors.forename: Harold
authors.initials: H
authors.lastname: Frazier
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012371:Robotics