title: Safety of minimally invasive radical prostatectomy in patients with prior abdominopelvic or inguinal surgery.
abstract: BACKGROUND
  Despite the widespread use of minimally invasive radical prostatectomy (MIRP), there remain concerns regarding its safety in patients with a history of prior abdominopelvic or inguinal surgery.
  
  
  METHODS
  A prospective database of 1165 MIRP procedures performed by a single surgeon at a high-volume tertiary care center from 2001 to 2013 was analyzed. After an initial period of transperitoneal MIRP (TP), an extraperitoneal (EP) approach was used preferentially beginning in 2005 (for both laparoscopic and robotic cases), and robotics were used preferentially beginning in 2010. Overall perioperative complications, major complications (Clavien-Dindo III or IV), and abdominal complications (e.g., ileus, bowel/organ injury, or vascular injury) were compared for patients with and without a prior surgical history. Uni- and multivariate logistic regression were used to control the impact of robotics, approach, operative time, estimated blood loss, case number, prostate weight, and primary Gleason on complications.
  
  
  RESULTS
  Three hundred patients undergoing MIRP had prior abdominopelvic or inguinal surgery (25.8%). Of these, 102 (34%) underwent TP and 198 (66%) EP MIRP. Robotics was used in 286 cases (24.6%) and pure laparoscopy in 879 (75.4%). Complications occurred in 111 patients (9.5%) from the total cohort, with major complications in 32 (2.75%) and abdominal complications in 19 (1.63%). Prior surgery was not associated with overall, major, or abdominal complications. Of the controlling factors, only increasing operative time was associated with postoperative abdominal complications (most of which were ileus) on multivariate analysis.
  
  
  CONCLUSIONS
  In this large single-surgeon series where both EP and TP approaches to MIRP are utilized, prior abdominopelvic or inguinal surgery was not associated with an increased risk of perioperative complications.
authors.affiliation: 1 Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University , Baltimore, Maryland.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Ball
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reese
authors.forename: Lynda Z
authors.initials: LZ
authors.lastname: Mettee
authors.forename: Christian P
authors.initials: CP
authors.lastname: Pavlovich
mesh_terms: D015142:Baltimore; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods