Contemporary Management of Hemorrhage After Minimally Invasive Radical Prostatectomy

Dean, Lucas W.; Tin, Amy; Chesnut, Gregory T.; Assel, Melissa; LaDuke, Emily; Fromkin, Jillian; Vargas, Hebert Alberto; Ehdaie, Behfar; Coleman, Jonathan; Touijer, Karim; Eastham, James A.; Laudone, Vincent P.

doi:10.1016/j.urology.2019.04.021

Cited by 10 publications

(13 citation statements)

References 19 publications

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“…Dean et al reported 151 cases of postoperative bleeding among 3749 laparoscopy-and robot-assisted prostatectomies. 1 Of these, 4% experienced clinically significant bleeding, 1.6% required a transfusion, and 0.32% underwent secondary procedures. In four cases, the postoperative bleeding included bleeding from the accessory pudendal artery, dorsal venous complex, neurovascular bundle, and obturator fossa; the source of the bleeding was unknown in seven cases.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Postoperative Hemorrhagic Shock 7 Days After Robot-Assisted Radical Prostatectomy

Fujisaki

Takayama

Yamazaki

et al. 2020

Journal of Endourology Case Reports

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Background: Delayed postoperative bleeding after robot-assisted radical prostatectomy (RARP) is a rare lifethreatening condition. We present such a case wherein a patient developed hemorrhagic shock from a ruptured pseudoaneurysm arising from the epigastric artery and discuss its management. Case Presentation: A 71-year-old man with prostate cancer underwent RARP. The urethral catheter was removed on postoperative day 7; 80 minutes later, the patient suddenly lost consciousness and went into shock. Enhanced CT revealed intra-abdominal bleeding; however, the cause was unknown. Intraoperatively, bleeding was observed from the anterior abdominal wall, which likely corresponded to the epigastric artery. However, this was controlled with monopolar electrocautery. Because of unstable hemodynamics, hemostasis was immediately performed by laparotomy, and bleeding was noted from the previously coagulated right inferior epigastric artery. Therefore, the cause was considered to be the rupture of a pseudoaneurysm. Conclusion: Our experience suggests that monopolar electrocautery may be inadequate for controlling bleeding that may be encountered during RARP, possibly leading to pseudoaneurysm formation, which may cause a delayed life-threatening hemorrhage. Meticulous and precise hemostasis is key to avoiding this complication.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Postoperative Hemorrhagic Shock 7 Days After Robot-Assisted Radical Prostatectomy

Fujisaki

Takayama

Yamazaki

et al. 2020

Journal of Endourology Case Reports

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“…A decrease in hemoglobin level by 30% or 40 g/l or need for blood transfusion was reported in the literature as clinically significant blood loss [ 37 ]. Considering these data, the difference of 10 g/l may seem insufficient.…”

Section: Discussionmentioning

confidence: 99%

Can the prophylactic administration of tranexamic acid reduce the blood loss after robotic-assisted radical prostatectomy? Robotic Assisted Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a randomized controlled trial

Balík

Košina

Hušek

et al. 2022

Trials

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Background The prophylactic administration of tranexamic acid reduces blood loss during procedures at high risk of perioperative bleeding. Several studies in cardiac surgery and orthopedics confirmed this finding. The aim of this prospective, double-blind, randomized study is to evaluate the effect of tranexamic acid on peri-and postoperative blood loss and on the incidence and severity of complications. Methods/design Based on the results of our pilot study, we decided to conduct this prospective, double-blind, randomized trial to confirm the preliminary data. The primary endpoint is to analyze the effect of tranexamic acid on perioperative and postoperative blood loss (decrease in hemoglobin levels) in robotic-assisted radical prostatectomy. The additional endpoint is to analyze the effect of tranexamic acid on postoperative complications and confirm the safety of tranexamic acid in robotic-assisted radical prostatectomy. Discussion No study to date has tested the prophylactic administration of tranexamic acid at the beginning of robotic-assisted radical prostatectomy. This study is designed to answer the question of whether the administration of tranexamic acid might lower the blood loss after the procedure or increase the rate and severity of complications. Trial registration ClinicalTrials.gov NCT04319614. Registered on 25 March 2020

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“…16 We previously observed that clinically significant hemorrhage, defined as a decrease in hemoglobin of at least 30% or 4 gm/dl, receipt of a blood transfusion within 30 days of surgery or requirement for a secondary procedure to control hemorrhage, occurs in 4% of cases in the minimally invasive era. 17 The current study evaluated the clinical role of routine postoperative hemoglobin monitoring in the contemporary era of MIRP. Although our transfusion rate was low at 1.2%, our practice of routine postoperative hemoglobin assessment has persisted despite the uncertain role of time designated laboratory assessment in clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

et al. 2020

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Introduction: An advantage of minimally invasive radical prostatectomy over open surgery is decreased blood loss. At our institution hemoglobin is routinely checked 4 and 14 hours postoperatively. We assessed the relevance of this practice in a contemporary cohort undergoing minimally invasive radical prostatectomy. Methods: We retrospectively reviewed data from patients undergoing laparoscopic or robotic radical prostatectomy at our institution between January 2010 and September 2018. We identified 3,631 patients with preoperative and postoperative hemoglobin values, and assessed the role of routine hemoglobin assessment in determining need for transfusion within 30 days. Medicare reimbursement rates for 2019 were used for cost analysis. Results: Of 3,631 patients in our cohort 44 (1.2%) required transfusion. At 4 hours following surgery the median hemoglobin decrease was 8.0% (IQR 4.8 to 11.4) for patients who did not receive transfusion and 12.5% (9.5 to 19.2) for those who received transfusion. At 14 hours the median decrease was 14.2% (IQR 10.0 to 18.4) vs 33.1% (22.6 to 38.6). Routine hemoglobin assessment had no role in the decision to transfuse in 18 patients (41%). No patient was transfused based on 4-hour values alone. Omitting 1 hemoglobin assessment could have resulted in institutional savings of $37,000 during this period.

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Contemporary Management of Hemorrhage After Minimally Invasive Radical Prostatectomy

Cited by 10 publications

References 19 publications

Postoperative Hemorrhagic Shock 7 Days After Robot-Assisted Radical Prostatectomy

Postoperative Hemorrhagic Shock 7 Days After Robot-Assisted Radical Prostatectomy

Can the prophylactic administration of tranexamic acid reduce the blood loss after robotic-assisted radical prostatectomy? Robotic Assisted Radical Prostatectomy with tranEXamic acid (RARPEX): study protocol for a randomized controlled trial

Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy

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