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Enhancing Care With Robotic Prostatectomy

Enhancing Care With Robotic Prostatectomy

During the last decade, the number of robot-assisted prostatectomies performed in the United States has risen steadily throughout the country. Several factors have led to more complex patients being offered surgery for organ-confined prostate cancer, including refined surgical techniques, a better understanding of anatomy, and more experience. Robot-assisted procedures help surgeons better visualize anatomy and control bleeding with the added benefit of increased dexterity. This has enabled surgeons to treat prostate cancers more effectively with fewer complications than was previously possible with traditional open surgery. Although rare, several studies have reported on complication rates associated with robot-assisted prostatectomy. However, few data exist when evaluating ureteral injuries that are sustained during these procedures. Further complicating matters is that there is no standardized universal criteria for reporting and grading of complications. “Identifying patient characteristics that may forewarn surgeons of such damage may further improve our ability to reduce complications,” says Jay K. Jhaveri, MD, MPH. Low Rates Observed In the Journal of Endourology, Dr. Jhaveri and colleagues had a study published that focused on 6,442 patients who underwent robotic prostatectomy by one of five surgeons over a 12-year period. Under the guidance of Mani Menon, MD, and James Peabody, MD, the study team found that three patients—operated on by two of the five surgeons—sustained complete transection of the ureter. One of the patients required readmission for further treatment. The study authors identified several risk factors that predisposed these patients to ureteral injury, including a history of: • Infection. • Abdominal surgery. • Radiation treatment. • Enlarged prostate glands. • Prior transurethral prostatic resection. Overall, the study group found a 0.046% rate...
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