ENDOUROLOGY & LAPAROSCOPY

doi: 10.1590/S1677-55382010000600019

Does prior abdominal surgery influence outcomes or complications of robotic-assisted laparoscopic radical prostatectomy?
Ginzburg S, Hu F, Staff I, Tortora J, Champagne A, Salner A, Shichman SJ, Kesler SS, Wagner JR, Laudone VP
University of Connecticut Health Center, Farmington, Connecticut, USA
Urology. 2010; 76: 1125-9

• Objectives: To determine whether robotic-assisted laparoscopic radical prostatectomy (RALP) in patients with prior abdominal surgery is associated with increased operating times, positive surgical margins, or complications.
  Methods: An institutional review board-approved retrospective review of a prospective, prostatectomy database was performed. Patients undergoing surgery between January 1, 2004, and February 29, 2008 were included. Transition from open retropubic prostatectomy to RALP took place through 2004, at which point all surgical candidates were offered RALP, regardless of prior surgical history. Learning curves from all surgeons were included. Patients with prior abdominal surgery were compared with those patients without prior surgery with respect to total operating time, robotic-assist time, surgical margin positivity, and rate of complications.
  Results: A total of 1083 patients underwent RALP between January 1, 2004, and February 29, 2008, at our institution; of these, 839 had sufficient data available for analysis. In all, 251 (29.9%) patients had prior abdominal surgery, whereas 588 (70.1%) had no prior abdominal surgery. Total operating times were 209 and 204 minutes (P = .20), robotic console times were 165 and 163 minutes (P = .59), and surgical margin positivity was 21.1% and 27.2% (P = .08) for patients with and without prior abdominal surgery, respectively. The incidence of complications was 14.3% and 17.3% for patients with and without prior abdominal surgery (P = .33).
  Conclusions: Prior abdominal surgery was not associated with a statistically significant increase in overall operating time, robotic assist time, margin positivity, or incidence of complications in patients undergoing RALP. Robotic prostatectomy can be safely and satisfactorily performed in patients who have had a wide variety of prior abdominal surgery types.

• Editorial Comment
  The authors presented complications of 839 men that underwent robotic-assisted laparoscopic radical prostatectomy. Approximately 1/3 of patients (251) had prior abdominal surgery, whereas 588 (70.1%) had no prior abdominal surgery. When these 2 groups were studied, operating times, robotic console times, and positive surgical margin were not significantly different for patients with and without prior abdominal surgery. Moreover, the incidence of complications was 14.3% and 17.3% for patients with and without prior abdominal surgery (p = 0.33). This study confirmed a well known data in other surgical specialties, including ours own, that previous abdominal surgery does not increase the morbidity of laparoscopic procedures. The pivotal issue of surgical techniques always point out to the surgeons’ experience with particular surgical technique.

Dr. Fernando J. Kim
Chief of Urology, Denver Health Med. Ctr.
Associate Professor, Univ. Colorado Health Sci. Ctr.
Director of Minimally Invasive Urol. Oncology, UCHSC
Denver, Colorado, USA
E-mail: fernando.kim@dhha.org