Clavien classification of complications after the initial series of robot-assisted radical prostatectomy: The cancer institute of new Jersey/Robert wood Johnson medical school experience

Purpose: To study the safety and feasibility of robot-assisted radical prostatectomy (RARP) for the surgical management of localized prostate cancer, we analyzed perioperative parameters and the pattern of complications in our patients who underwent RARP. Patients and Methods: After the performance of more than 600 RARP over a 4-year period by a single surgeon using the daVinci® robot system at the Cancer Institute of New Jersey/Robert Wood Johnson Medical School, we reviewed the medical records of the first 200 patients retrospectively. All patients were divided into four groups according to the order of case numbers to compare intergroup differences in preoperative characteristics and perioperative parameters. Perioperative complications were determined in all patients, and complications were classified according to the Clavien classification system. Results: The mean operative time was 212 minutes, and the mean blood loss was 189 mL. The mean length of hospital stay was 1.13 days. Overall, 12% (24 men) experienced various perioperative complications among the 200 patients. Of the total 24 patients, 5 (20.8%) men experienced intraoperative complications, and 19 (79.2%) men showed postoperative complications. Rectal injury occurred in two (8.3%) men, and the injury was repaired primarily using two-layer suture techniques without any sequelae. Three (12.5%) patients had femoral neuropathy, and urinary retention developed in 7 (25.0%) patients. Among our 200 patients, no transfusion was needed intraoperatively and postoperatively. There were nine (4.5%) patients in the Clavien grade I complications category, and another 9 (4.5%) men were classified as grade II complications. Six (3.0%) men had grade IIIb complications, and there were no grade IV or V complications. Conclusions: In our initial series of RARP procedures, we experienced low morbidity, with the overall complication rate of 12%. After implementing minor modifications, most of the early complications were prevented. Rectal injuries, if recognized intraoperatively, can be repaired primarily.