title: Abdominal wall haemorrhage after robotic-assisted radical prostatectomy: is it a complication of robotic surgery?
abstract: OBJECTIVE
  Robotic-assisted radical prostatectomy (RARP) is the minimally invasive surgical treatment for patients with localized prostate cancer. Perioperative or postoperative complications following RARP have been reported in some studies and severe postoperative bleeding after RARP is rare, but hemodynamic instability may necessitate open surgical exploration and be associated with considerable morbidity. We reported postoperative bleeding cases, which is a kind of complication associated with robotic surgery and requiring massive transfusion after RARP.
  
  
  METHODS
  From August 2009 to May 2012, 317 consecutive patients who underwent RARP performed at our institution were analyzed. Patients with serious postoperative bleeding that caused hemodynamic instability after surgery were enrolled.
  
  
  RESULTS
  A total of 5 among 317 (1.6%) patients had bleeding requiring postoperative transfusion. In these cases, mean operative time was 114 min. The mean estimated blood loss was 110 ml during operation. In these patients, hematocrit (Hct) levels gradually fell after surgery and ecchymosis was detected on the side and posterior walls of the abdomen on the second day. The mean preoperative Hct was 44.3% and mean lowest Hct was 23.1%. All patients were successfully treatment without surgical exploration.
  
  
  CONCLUSIONS
  Robotic radical prostatectomy has proven to be a safe surgical treatment with low morbidity. However, postoperative bleeding can reach serious problems. This is the first study to explain haemorrhage, associated with possible risk of robotic surgery.
authors.affiliation: Departamento de Urología, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Estambul, Turquía.
authors.forename: A I
authors.initials: AI
authors.lastname: Tasci
authors.forename: A
authors.initials: A
authors.lastname: Simsek
authors.forename: V
authors.initials: V
authors.lastname: Tugcu
authors.forename: A
authors.initials: A
authors.lastname: Bitkin
authors.forename: E
authors.initials: E
authors.lastname: Sonmezay
authors.forename: B D
authors.initials: BD
authors.lastname: Torer
mesh_terms: D034861:Abdominal Wall; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics
keywords: Complicación; Complication; Cáncer de próstata; Hemorragia postoperatoria; Postoperative bleeding; Prostate cancer; Prostatectomía radical asistida por robot; Robotic-assisted radical prostatectomy