Common surgical errors and pitfalls during RARP - experience from a high volume center



L. Dutto*1, C. Wagner1, J. Witt1

1Prostatazentrum Nordwest, St. Antonius-Hospital, Gronau, Deutschland

Background: robotic assisted radical prostatectomy (RARP) is a complex procedure with a steep learning curve[1,2,3,4].Numerous publications and surgical videos have described the most serious and significant complications that may occur duringthis procedure.There are however a series of less serious surgical errors that are often committed when performing RARP. These mistakes -which may or may not lead to complications - have not often been described. Nonetheless they could play a role for operativetimes, complications and for the standardization of oncological and functional results within an institution's learning curve.Our institution is a high volume center for radical prostatectomies (>7000 RARP/year) and a high volume training center forRARP, with 2 fellows trained per year and 14 surgeons trained so far.We would like to share our experience on those mistakes that are commonly made during the acquisition of this complextechnique.

Aim of the Video: to describe the most common surgical and technical mistakes that may occur during RARP.

Materials and methods: complications and surgical errors were retrospectively collected from our institution's patient- andvideo database.The video footage was edited and the surgical errors were presented in a modular fashion that reflects the steps of RARP. Inaddition, we analyzed how such mistakes are generated and attempted to summarize how they may be avoided by establishinga list of surgical bullet points for each step.

Results and conclusions: RARP is difficult to master. We attempted to establish a list of surgical principles to keep in mindduring RARP. We think that these principles may result to be useful for less experienced-, as well as for veteran surgeons whoare approaching RARP.

References:1: Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg JU,Van Poppel H, Zattoni F, Montorsi F, Mottrie A, Wilson TG. Systematic review and meta-analysis of perioperative outcomes andcomplications after robot-assisted radical prostatectomy. Eur Urol. 2012 Sep;62(3):431-52.2. Murphy DG, Bjartell A, Ficarra V, Graefen M, Haese A, Montironi R, Montorsi F, Moul JW, Novara G, Sauter G, Sulser T, vander Poel H. Downsides of robot-assisted laparoscopic radical prostatectomy: limitations and complications. Eur Urol. 2010May;57(5):735-463. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, Guazzoni G, Guillonneau B, Menon M, Montorsi F, PatelV, Rassweiler J, Van Poppel H. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review andcumulative analysis of comparative studies. Eur Urol. 2009 May;55(5):1037-63.4. Thompson JE, Egger S, Böhm M, Haynes AM, Matthews J, Rasiah K, Stricker PD. Superior quality of life and improvedsurgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeonstudy of 1552 consecutive cases. Eur Urol. 2014 Mar;65(3):521-31

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