Rectal injury during robot-assisted radical prostatectomy: Incidence and management

Alexei Wedmid, Pierre Mendoza, Saurabh Sharma, Rachel L. Hastings, Kelly P. Monahan, Mary Walicki, Thomas E. Ahlering, James Porter, Erik P Castle, Faisal Ahmed, Jason D. Engel, Harold A. Frazier, Daniel Eun, David I. Lee

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1928-1933
Number of pages6
JournalJournal of Urology
Volume186
Issue number5
DOIs
StatePublished - Nov 2011

Fingerprint

Prostatectomy
Incidence
Wounds and Injuries
Fistula
Dissection
Seminal Vesicles
Prostate

Keywords

  • intraoperative complications
  • prostate
  • prostatectomy
  • rectum
  • robotics

ASJC Scopus subject areas

  • Urology

Cite this

Wedmid, A., Mendoza, P., Sharma, S., Hastings, R. L., Monahan, K. P., Walicki, M., ... Lee, D. I. (2011). Rectal injury during robot-assisted radical prostatectomy: Incidence and management. Journal of Urology, 186(5), 1928-1933. https://doi.org/10.1016/j.juro.2011.07.004

Rectal injury during robot-assisted radical prostatectomy : Incidence and management. / Wedmid, Alexei; Mendoza, Pierre; Sharma, Saurabh; Hastings, Rachel L.; Monahan, Kelly P.; Walicki, Mary; Ahlering, Thomas E.; Porter, James; Castle, Erik P; Ahmed, Faisal; Engel, Jason D.; Frazier, Harold A.; Eun, Daniel; Lee, David I.

In: Journal of Urology, Vol. 186, No. 5, 11.2011, p. 1928-1933.

Research output: Contribution to journalArticle

Wedmid, A, Mendoza, P, Sharma, S, Hastings, RL, Monahan, KP, Walicki, M, Ahlering, TE, Porter, J, Castle, EP, Ahmed, F, Engel, JD, Frazier, HA, Eun, D & Lee, DI 2011, 'Rectal injury during robot-assisted radical prostatectomy: Incidence and management', Journal of Urology, vol. 186, no. 5, pp. 1928-1933. https://doi.org/10.1016/j.juro.2011.07.004
Wedmid A, Mendoza P, Sharma S, Hastings RL, Monahan KP, Walicki M et al. Rectal injury during robot-assisted radical prostatectomy: Incidence and management. Journal of Urology. 2011 Nov;186(5):1928-1933. https://doi.org/10.1016/j.juro.2011.07.004
Wedmid, Alexei ; Mendoza, Pierre ; Sharma, Saurabh ; Hastings, Rachel L. ; Monahan, Kelly P. ; Walicki, Mary ; Ahlering, Thomas E. ; Porter, James ; Castle, Erik P ; Ahmed, Faisal ; Engel, Jason D. ; Frazier, Harold A. ; Eun, Daniel ; Lee, David I. / Rectal injury during robot-assisted radical prostatectomy : Incidence and management. In: Journal of Urology. 2011 ; Vol. 186, No. 5. pp. 1928-1933.
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abstract = "Purpose: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.",
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