Rectal Injury During Robot-Assisted Radical Prostatectomy: Incidence and Management
- 30 November 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 186 (5), 1928-1933
- https://doi.org/10.1016/j.juro.2011.07.004
Abstract
Rectal injury during robot-assisted radical prostatectomy is a rare but significant complication. Since the Clavien grading classification of complications does not include intraoperative injury without further sequelae, rectal injury may be underreported in the literature. We present what is to our knowledge the largest retrospective review to date of rectal injury and subsequent management. We reviewed the records of 6,650 patients who underwent robot-assisted radical prostatectomy at a total of 6 institutions. Patient characteristics, perioperative parameters, pathological findings and rectal injury management were tabulated and analyzed for intraoperative predictors of outcome and subsequent management. A total of 11 rectal injury cases were identified of the 6,650 robot-assisted radical prostatectomies for a combined 0.17% incidence of rectal injury. Of rectal injuries 72.7% were identified intraoperatively and most did well with primary closure. Delayed recognition injury presented as rectourethral fistula without septic complications and required delayed fistula repair after primary diversion. We found no conclusive association of rectal injury with any patient parameter, intraoperative differences, pathological finding or surgeon experience. Posterior prostate plane dissection, including seminal vesicle dissection, is the crucial stage when rectal injury can occur and be identified. Our review of the records at 6 centers revealed a combined 0.17% incidence of rectal injury. This compares favorably to the incidence in modern open and laparoscopic radical prostatectomy series. No preoperative, intraoperative or pathological differences correlated with injury. Cases in which rectal injury was identified intraoperatively required fewer surgical repeat interventions but ultimately each group had acceptable long-term urinary and bowel function results.Keywords
This publication has 12 references indexed in Scilit:
- Management of Rectal Injury During Robotic Radical ProstatectomyUrology, 2011
- Early Complication Rates in a Single-Surgeon Series of 2500 Robotic-Assisted Radical Prostatectomies: Report Applying a Standardized Grading SystemEuropean Urology, 2010
- Prospective Evaluation With Standardised Criteria for Postoperative Complications After Robotic-Assisted Laparoscopic Radical ProstatectomyEuropean Urology, 2010
- Repair of Rectal Injury During Robotic-Assisted Laparoscopic ProstatectomyUrology, 2008
- Management of rectal injury during laparoscopic radical prostatectomyInternational braz j urol, 2006
- Laparoscopic Versus Open Radical Prostatectomy: A Comparative Study at a Single InstitutionJournal of Urology, 2003
- INTRAOPERATIVE AND POSTOPERATIVE COMPLICATIONS OF RADICAL RETROPUBIC PROSTATECTOMY IN A CONSECUTIVE SERIES OF 1,000 CASESJournal of Urology, 2001
- POTENCY, CONTINENCE AND COMPLICATION RATES IN 1,870 CONSECUTIVE RADICAL RETROPUBIC PROSTATECTOMIESJournal of Urology, 1999
- The Management of Rectal Injury During Radical Retropubic ProstatectomyJournal of Urology, 1992
- Management of Rectal Injury and Rectourethral Fistulas following Radical Retropubic ProstatectomyJournal of Urology, 1972