An Updated Report on Complications Following Robotic Prostatectomy: Results of an Unbiased Prospective Database

Abstract

INTRODUCTION: The application of robotic-assisted radical prostatectomy has increased considerably over the past decade, but there remains a paucity of standardized complications reporting associated with this procedure. The complications literature regarding robotic prostatectomy is wrought with limitations, variability, and bias making meaningful comparisons between surgical series difficult. MATERIALS AND METHODS: From November 2006 to December 2010, a total of 575 patients were evaluated. Data were assimilated through an IRB-approved blinded prospective database by an independent third party committee. Patients were followed prospectively for 30 days postoperatively. The Modified Clavien system was utilized to grade complications. Grade I and II complications were classified as minor, while grade III, IV, and V were considered major complications. Multiple complications in individual patients were recorded as separate events. Our initial experience and that of our most recent were compared. Age, body mass index, American Society of Anesthesiologists score, Gleason grade, prostate specific antigen, prostate volume, and complications were evaluated. RESULTS: Of the 575 patients, 482 (83.8%) had an ideal perioperative course. In the remaining 93 (16.2%) patients, there were 117 complications. Minor complications occurred in 84 (14.6%) and major complications arose in 15 (2.6%) patients. When the first 500 patients were divided into subsets of 100 patients, a linear regression analysis demonstrated no significant difference in overall complications among the five quintiles (p=0.17). The first quintile was found to have a significantly higher major complication rate compared with the second quintile (p=0.05). The subsequent quintiles exhibited no significant change in major complication rate. CONCLUSIONS: As a surgeon progresses through the learning curve, there is a stable overall complication rate with a drop in major complications after the first 100 cases.