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Purpose: To assess the impact of eliminating routine drain placement in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND) on the risk of postoperative complications. Patients and Methods: An experienced single surgeon performed RALP on 651 consecutive patients at our institution from 2008 to 2012. Before August 2011, RALP with or without PLND included a routine peritoneal drain placed during surgery. Thereafter, routine intraoperative placement of drains was omitted, except for intraoperatively noted anastomotic leakage. We used multivariable logistic regression to compare complication rates between study periods and the actual drain placement status after adjusting for standard prespecified covariates. Results: Most patients (92%) did not have ‡ grade 2 complications after surgery and only two patients (0.3%) experienced a grade 4 complication. The absolute adjusted risk of a grade 2-5 complication was 0.9% greater among those treated before August 2011 (95% confidence interval [CI] -3.3%-5.1%; p = 0.7), while absolute adjusted risk of a grade 3-5 complication was 2.8% less ( -2.8%; 95% CI -5.3%-0.1%; p = 0.061). Results based on drain status were similar. Conclusions: Routine peritoneal drain placement following RALP with PLND did not confer a significant advantage in terms of postoperative complications. Further data are necessary to confirm that it is safe to omit drains in most patients.

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Objectives To prospectively analyse robotically administered transperitoneal transversus abdominis plane (robot‐assisted transversus abdominis plane [RTAP]) compared with both ultrasonography‐guided transversus abdominis plane (UTAP) and local anaesthesia (LA) with regard to pain control and narcotic use in patients undergoing robot‐assisted prostatectomy (RARP) or robot‐assisted partial nephrectomy (RAPN). Subjects/Patients and Methods Patients undergoing RARP or RAPN were randomized in a single‐blind 2:2:1 fashion to RTAP:UTAP:LA, with the study powered to evaluate superiority of UTAP to LA and non‐inferiority of RTAP to UTAP. We compared time to deliver the block, operating room time, postoperative pain scores using the visual analogue scale, and intra‐operative and postoperative analgesia consumption. Results A total of 143 patients were randomized and received treatment. There was no significant difference in patient baseline characteristics. UTAP did not demonstrate superiority to LA in terms of pain control. RTAP and LA were faster to administer than UTAP (time to perform block 2.5 vs 2.5 vs 6.25 min; P < 0.001). There was no difference in postoperative narcotic, acetaminophen, ketorolac or ondansetron requirements among the three groups (P > 0.05). The study was terminated early due to the unexpected efficacy of LA. Conclusion This study showed that UTAP and RTAP do not provide superior pain control to LA. The efficiency, effectiveness, and ease of administration of LA make it an excellent option for first‐line therapy for postoperative analgesia.