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

Highlights

• RALP patients are at three times the risk for postoperative ventral wall hernia.

• RALP patients may be at mild increased risk for corneal abrasion.

• RRP patients are at greater risk for inguinal herniae and LE edema and pain.

Abstract

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.

Introduction

The debate regarding the advantages and disadvantages of robot-assisted laparoscopic prostatectomy (RALP) and open radical retropubic prostatectomy (RRP) has largely been resolved. Currently, most evidence purporting the superiority of RALP has come from observational cohort studies and meta-analyses [1], [2], [3], [4], [5]. To date, no extensive randomized controlled trial comparing the two techniques has been performed [6], [7].

Given equivalent cancer control, urinary continence recovery, and erectile function return [12], [13], [14], the main justifications given for added expense of a surgical robot are decreased blood loss and shorter length of hospital stay (LOS) [8], [9], [10], [11]. Preliminary comparative assessments of less frequent nongenitourinary complications have been performed, including inguinal and umbilical hernia occurrence [15], [16], [17], [18], [19], [20], ophthalmic complications [21], [22], and upper extremity (UE) [23], [24] and lower extremity (LE) complications [25], [26], [27].

We provide further evaluation of nongenitourinary RALP and RRP complications and outcomes over an 11-year interval.