Robotic RP associated with low numbers of peri-operative complications
MedWire News: Prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy (RALRP) experience low rates of peri-operative complications, even when the procedure is carried out by surgeons new to the technique, report researchers.
In a study reporting 30-day complications in the first patients to undergo RARLP at a center, the researchers developed a strict definition of an ideal peri-operative course, in an effort to “better counsel patients during treatment management.”
Gyan Pareek, from Rhode Island Hospital in Providence, USA, and co-authors explain: “Although the efficacy of RARLP is becoming less controversial, defining the complication rates of the procedure remains a challenging task.”
The team defined the ideal peri-operative course as discharge from hospital within 2 days of surgery, removal of the Jackson-Pratt drain before discharge, and no unscheduled procedures or re-admissions to hospital.
Among the 239 RARLP patients involved in the current study, the average stay in hospital was 2.3 days, and 198 patients experienced an ideal peri-operative course. In the remaining 41 patients, the researchers observed 55 complications.
Complications were graded according to the Modified Clavien system with grades 1–3 representing minor complication and grades 4 and 5 representing major complications.
In all, 35 patients experienced 53 minor complications including postoperative transfusions, small bowel perforation, and inadvertent removal of the Foley catheter in the immediate postoperative period.
Two patients experienced grade 4 or 5 complications including one conversion to open prostatectomy and one peri-operative death.
The researchers remark that the study represents one center’s initial experience using a robotic-assisted approach to RP, and that as surgeon experience improved, operative time was reduced and fewer patients required postoperative transfusion.
“We have demonstrated that the RALRP is safe during the learning curve and therefore is a viable procedure, even in robotic-naïve surgeons,” conclude Pareek et al in the journal Urology.
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By Sarah Guy