Prevention and management of complications during robotic-assisted laparoscopic radical prostatectomy

Abstract

The recent introduction of the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) to the field of urologic surgery has added new hopes of reducing morbidity and the learning curve for minimally invasive radical prostatectomy due to its technological peculiarities, such as three-dimensional (3D) vision, 7 degrees of freedom, and magnification. However, as expected, the introduction of any innovative technology or surgical procedure is associated with an initial learning curve and with the potential of eliciting new risks and surgical complications. To date, few series have evaluated the risk of complications following robotic-assisted radical prostatectomy (RARP), despite the publication of several studies reporting perioperative data and early functional and oncologic outcomes related to the procedure. Even fewer studies have used standardized systems to classify surgical complications, which has hampered accurate comparisons between different series or surgical approaches. In this chapter we discuss surgical complications after RARP and how to prevent them. Patient positioning, port placement, and intraoperative and postoperative complications are addressed. Complication rates in the RARP series currently available in the literature are also analyzed.