title: Preventing perioperative complications of robotic-assisted radical prostatectomy.
abstract: OBJECTIVE
  To report the change in complication rates after the identification and modification of technique to reduce their incidence during robot-assisted radical prostatectomy (RARP).
  
  
  METHODS
  This study retrospectively reviewed 1000 consecutive patients who underwent RARP from June 2002 to June 2011. A number of technical changes were made after complications were noted and changes in technique were documented. The Fisher exact test and multivariate analysis were used for comparison of techniques, and values of P <.05 were considered significant.
  
  
  RESULTS
  The overall rate of major and minor complications was 10.8% (108 of 1000). The complication rates of lymphoceles (0.4%), ileus (0.4%), and wound infection (0.4%) were low and did not require technical changes. There were no significant changes in rates of femoral nerve palsies, rectal injuries, or bladder neck contractures. There was statistically significant change in corneal abrasions (P = .03), fossa navicularis strictures (P = .03), and camera-site hernias (P <.001) after a directed intervention adjusted for age, body mass index, and learning curve. Clavien 3 and 4 complications all significantly decreased to ≤ 0.6%, with the most occurring in the first 200 cases.
  
  
  CONCLUSIONS
  Identification and correction of perioperative complications in patients undergoing robotic prostatectomy has decreased the incidence of major and minor complications adjusted for learning curve. The conscientious monitoring of adverse events can provide targeted change in technique to decrease complications and provide information to those early in learning robotic-assisted radical prostatectomy.
authors: Department of Urology, University of California, Irvine, CA, USA. mliss@ucsd.edu
authors: Michael A
authors: MA
authors: Liss
authors: Douglas
authors: D
authors: Skarecky
authors: Blanca
authors: B
authors: Morales
authors: Kathryn
authors: K
authors: Osann
authors: Louis
authors: L
authors: Eichel
authors: Thomas E
authors: TE
authors: Ahlering
mesh_terms: D015992:Body Mass Index; D002983:Clinical Competence; D006547:Hernia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000517:prevention & control; D059032:Learning Curve; D008210:Lymphocele / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059035:Perioperative Period; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D012007:Rectum / Q000293:injuries; D012189:Retrospective Studies; D012371:Robotics; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D014525:Urethral Stricture / Q000209:etiology / Q000517:prevention & control; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
references: J Endourol. 2007 Apr;21(4):441-7
references: 17451340
references: Eur Urol. 2011 May;59(5):684-98
references: 21324583
references: J Obstet Gynaecol. 2011;31(1):90-1
references: 21281008
references: Urology. 2012 Mar;79(3):626-31
references: 22245303
references: Urology. 2011 Sep;78(3):586-90
references: 21741689
references: J Endourol. 2008 Oct;22(10):2299-305
references: 18837657
references: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references: 21296855
references: J Urol. 2001 Nov;166(5):1729-33
references: 11586211
references: BJU Int. 2010 Dec;106(11):1567-9
references: 21125712
references: Urol Clin North Am. 2010 Feb;37(1):37-47, Table of Contents
references: 20152518
references: Eur Urol. 2012 Sep;62(3):431-52
references: 22749853
references: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD005199
references: 16235395
references: Hernia. 2009 Jun;13(3):275-80
references: 19259615
references: J Urol. 1999 Aug;162(2):433-8
references: 10411052
references: Eur Urol. 2012 Jul;62(1):1-15
references: 22405509
references: Eur Urol. 2012 Nov;62(5):779-90
references: 22664219
references: Prostate Cancer Prostatic Dis. 2012 Mar;15(1):1-7
references: 21844888
references: BJU Int. 2011 Aug;108(3):420-5
references: 21050363
references: Eur Urol. 2009 May;55(5):1037-63
references: 19185977
references: J Urol. 2006 Jun;175(6):2201-6
references: 16697841
references: J Urol. 1998 Dec;160(6 Pt 2):2418-24
references: 9817395
references: JSLS. 2007 Jul-Sep;11(3):321-5
references: 17931514
references: JAMA. 2009 Oct 14;302(14):1557-64
references: 19826025
references: Urology. 2010 May;75(5):1092-7
references: 20022085
references: Chirurg. 2002 Sep;73(9):881-7
references: 12297952
references: AORN J. 2011 Jul;94(1):37-45; quiz 46-8
references: 21722770