Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy

Abstract

Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension, surgeon, prostate volume and anastomotic leakage as variables. Owing to a low number of events, multivariable analyses only included smoking status, diabetes and prostate volume for anastomotic leakage, and age, smoking status, prostate volume and anastomotic leakage for anastomotic strictures. Results The frequency of anastomotic leakage was 2.9%. Anastomotic stricture was seen in 4.9% of patients during follow-up. No differences were found in the frequency of anastomotic leakage (p = 0.35) or strictures (p = 0.35) between RRP and RARP. Univariate analysis demonstrated an association between surgeon and the risk of anastomotic strictures in RRP patients (p = 0.02). No other independent risk factors were identified. Conclusion Overall, the anastomotic complication rate in this cohort is similar to other published reports. No obvious risk factors for anastomotic complications could be identified, which in part was due to the low number of events.

Vesicourethral Anastomotic Stenosis After Open or Robot-assisted Laparoscopic Retropubic Prostatectomy—Results from the Laparoscopic Prostatectomy Robot Open Trial

“…There are few reported comparisons of stenosis formation after RRP and RALP. We found 3.6% stenosis after RRP and 1.3% after RALP, both in the lower range of previously reported incidences from studies on RRP of 2.7-15% [5,13,[20][21][22] and RALP 1.1-3.8% [8,9,14,15,23,24]. In a study in 2012, Wang et al [12] showed a stenosis incidence of 7.5% after RRP (n = 707) and 2.1% after RALP (n = 1038).…”

“…The exact aetiology of stenosis formation is largely unknown, but proposed risk factors include age, elevated body mass index (BMI), smoking, anastomotic suture technique, anastomotic urinary leakage, and excessive blood loss [12,13]. There are few studies comparing the risk of stenosis after open and robot-assisted radical prostatectomy, most hampered by small size, few observations of stenosis, and/or a nonrandomised design [8,14,15]. The large number of patients undergoing prostatectomy emphasises the need for further exploring this relatively common side effect.…”

Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

“…In 2008, Artibani and colleagues published their initial 41 cases and described one bladder-urethra anastomosis dehiscence, which required reintervention, and one bladder-urethra anastomosis stenosis using monofilament suture ( 20 ). Recently Jacobsen et al reported their data from 236 consecutive patients, with an anastomotic leakage frequency of 2.9%, and anastomotic stricture of 4.9% ( 28 ). In another study that assessed complications during early experience of RARP, among 322 patients, urine leakage developed in 24 (7.5%) and anastomotic strictures requiring transurethral incision developed in 2 cases (0.3%) ( 29 ).…”

Robotic urologic surgery complications

“…Jacobsen et al [13] reported the rate of the urinary leakage as 2.1% in their study including 236 RARP patients. Age, smoking, diabetes mellitus, hypertension and prostate volume were not found to be associated with anastomotic leakage.…”