Nongenitourinary complications associated with robot-assisted laparoscopic and radical retropubic prostatectomy: A single institution assessment of 1,100 patients over 11 years.

OBJECTIVES: Robot-assisted laparoscopic prostatectomy (RALP) and radical retropubic prostatectomy (RRP) provide similar outcomes in terms of biochemical recurrence, postoperative continence, and erectile function. Little is known about other complications of these procedures. To further address this, we examined patient outcomes at our institution over an 11-year period. METHODS: A retrospective review of 1,113 prostatectomies (646 RALP and 467 RRP) performed over 11 years by 9 different urologists at a single U.S. academic center was undertaken. Preoperative data collected included age, body mass index (BMI), prostate-specific antigen (PSA), biopsy Gleason score, and tumor (T) stage. Postoperative data included pelvic lymph node dissection (PLND), intensive care unit (ICU) admission rate, length of stay (LOS), ileus, wound infection rate, umbilical hernia occurrence, inguinal hernia occurrence, ophthalmic complications, upper and lower extremity complications, postoperative neuropathy, residual cancer, and cancer recurrence. RESULTS: Significant differences between RRP and RALP included performance of PLND (54.1% vs. 35.9%, P < 0.0001 respectively), umbilical hernia rates (2.4% vs. 6.5%, P = 0.0015, respectively), inguinal hernia rates (5.4% vs. 2.5%, P = 0.0101, respectively), and LE complications (9.0% vs. 5.1%, P = 0.016, respectively). No difference was observed regarding ICU admission, LOS, ileus, wound infection, and ophthalmic or upper extremities complications. CONCLUSIONS: RRP patients were more likely to have lower extremity complications and inguinal herniae, whereas RALP patients had an increased umbilical hernia rate and a trend toward more corneal abrasions.

Bladder Neck Contracture Following Radical Retropubic versus Robotic-Assisted Laparoscopic Prostatectomy.

INTRODUCTION: Radical retropubic prostatectomy (RRP) and robotic-assisted laparoscopic prostatectomy (RALP) are co-standard surgical therapies for localized prostatic adenocarcinoma. These surgical modalities offer similar outcomes; however, lower rate of bladder neck contracture (BNC) is amongst the touted benefits of RALP. The differences between approaches are largely elucidated through multiple-surgeon comparisons, which can be biased by differential experience and practice patterns. We aimed to eliminate inter-surgeon bias through this single-surgeon comparison of BNC rates following RRP and RALP. MATERIALS AND METHODS: We retrospectively reviewed all RRPs and RALPs performed by one surgeon over 4 years. We compared clinical characteristics, intraoperative and postoperative outcomes. RESULTS: RRP patients had more advanced cancer and a higher biochemical recurrence rate. No significant differences were noted between groups in rates of anastomotic leakage, BNC, or 12-month postoperative pad-free continence. CONCLUSION: RRP offers similar outcomes to RALP with regard to postoperative urinary extravasation, urinary continence, and BNC.

Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy.

BACKGROUND: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. METHODS: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). RESULTS: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). CONCLUSION: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

Use of blunt right angles to aid in intussusception of a Bricker ileal conduit.

The Bricker ileal conduit has been the most popular urinary diversion technique following a radical cystectomy since the 1950s. The procedure typically provides a high quality of life for patients. However, stomal complications occur in 16%-65% of ileal conduit cases. We describe an easy technique to aid in the intussusception of a Bricker ileal conduit. This technique produces stomas with a height of 2 cm-3 cm consistently. In our experience, we have had excellent results when using this technique.