title: Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery.
abstract: BACKGROUND
  The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video.
  
  
  OBJECTIVE
  We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care.
  
  
  METHODS
  Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015.
  
  
  METHODS
  Surgical footage was available for a variety of complications during RARP.
  
  
  METHODS
  Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined.
  
  
  CONCLUSIONS
  As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable.
  
  
  CONCLUSIONS
  Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve.
  
  
  RESULTS
  Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
authors.affiliation: Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA. Electronic address: renesotelo@mac.com.
authors.forename: René J
authors.initials: RJ
authors.lastname: Sotelo
authors.affiliation: Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.affiliation: Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela.
authors.forename: Victor
authors.initials: V
authors.lastname: Machuca
authors.affiliation: Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela.
authors.forename: Luis
authors.initials: L
authors.lastname: Medina
authors.affiliation: Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela.
authors.forename: Luciano
authors.initials: L
authors.lastname: Nuñez
authors.affiliation: Hospital Evita Pueblo, Buenos Aires, Argentina.
authors.forename: Flavio
authors.initials: F
authors.lastname: Santinelli
authors.affiliation: Hope Urology Center, Mexico.
authors.forename: Andrés
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: Acibadem Maslak Hospital, Sarıyer, Turkey.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
authors.affiliation: OVL Hospital, Aalst, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Marly Clinic, Bogota, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Giedelman
authors.affiliation: Centro Clinico Mae de Deus, Porto Alegre, Brazil.
authors.forename: Mariano
authors.initials: M
authors.lastname: Mirandolino
authors.affiliation: Global Robotics Institute, Celebration, FL, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Palmer
authors.affiliation: Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Montefiori Medical Center, Bronx, NY, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Ghavamian
authors.affiliation: Duchossois Center for Advanced Medicine, Chicago, IL, USA.
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
authors.affiliation: Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA.
authors.forename: Alireza
authors.initials: A
authors.lastname: Moinzadeh
authors.affiliation: Global Robotics Institute, Celebration, FL, USA.
authors.forename: Vipul
authors.initials: V
authors.lastname: Patel
authors.affiliation: New York University Langone Medical Center, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Stifelman
authors.affiliation: St. Elizabeth's Medical Center, Brighton, MA, USA.
authors.forename: Ingolf
authors.initials: I
authors.lastname: Tuerk
authors.affiliation: Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Canes
mesh_terms: D001808:Blood Vessels / Q000293:injuries; D004868:Equipment Failure; D006801:Humans; D000069290:Incisional Hernia / Q000209:etiology; D007416:Intestinal Perforation / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D007858:Learning; D008297:Male; D056888:Patient Positioning; D059348:Peripheral Nerve Injuries / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011468:Prostatectomy; D012002:Rectal Diseases / Q000209:etiology*; D065287:Robotic Surgical Procedures; D014513:Ureter / Q000293:injuries
keywords: Prostate; Robotic surgery