Complications in robotic urological surgeries and how to avoid them: A systematic review

Abstract

ObjectivesTo review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues.MethodsA systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it.ResultsIn all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored.ConclusionsAdequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.

The effectiveness of multiparametric magnetic resonance imaging in bladder cancer (Vesical Imaging-Reporting and Data System): A systematic review

“…Clinical management of bladder cancer is currently determined mainly based on clinical T Stage determination using transurethral resection of bladder tumour (TURBT) as a diagnostic and therapeutic surgical tool [4]. By reporting tumour invasion at the time of TURBT, urologists are able to decide whether to proceed with radical cystectomy, a morbid procedure associated with impaired quality of life [5][6][7], or in the case of nonmuscle-invasive bladder cancer (NMIBC) to treat the tumour with less invasive methods, such as TURBT followed by adjuvant intravesical instillation. In this regard, TURBT is not a perfect diagnostic and therapeutic tool, with an up to 50% residual tumour rate and 10% progression rate diagnosed at re-TURBT [8].…”

Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study

“… 19 20 Despite the advantages of the RALP technique, 21 the robotic surgery requires CP in STP and may involve various complications. 22 A current study found that whole-blood viscosity significantly increased in 58 patients undergoing RALP, but no severe postoperative complications were observed. 23 In this study, three patients (5.8%) developed adverse cardiac events like heart insufficiency and ischaemia.…”

Evolution of surgical steps in robotics-assisted donor surgery for uterus transplantation: results of the eight cases in the Swedish trial

“…This is the first publication on the progression of a stepwise approach on MIS for uterus procurement in a human clinical UTx trial. The study protocol was to limit the time for robotic surgery with the steep Trendelenburg position for the patient for 6-7 h, to minimize risk for serious side-effects that may come from a long duration in this position (15). Therefore, before the study we had identified certain steps of the robotic surgery that could progressively be completed by robotics.…”

“…The safety committee had decided before the start of the study that the maximum robotic surgical time would be 6 h in the initial procedures and that an extension toward 7 h would be possible for the last procedures, in the event that no serious complication related to the robotic surgery or the position of the patient was seen in the initial procedures. This was to minimize donor risks related to robotic surgery or to the long duration in a steep Trendelenburg position, comprising described complications such as compartment syndrome, skin lesions, peripheral nerve injury, rhabdomyolysis, and ocular events, including blindness (15).…”