Jhaveri et al. and colleagues have produced a timely report on the incidence of ureteric injuries during robot assisted radical prostatectomy. They reviewed the complications of 6442 consecutive patients treated with robot assisted prostatectomy at the same institution by one of five surgeons between January 2001 and June 2013. All complications were documented through a prospectively maintained prostate cancer database. The authors used the Martin-Donat criteria to report surgical complications and the Clavien-Dindo classification to report severity of complications. The team had a 0.046% (n=3) rate of ureteral injuries. All three injuries were transection type injuries. Furthermore all three patients had risk factors for ureteric injuries including previous surgeries (bilateral inguinal hernia repair and kidney transplant) and previous pelvic irradiation. These factors make for a more extensive adhesiolysis placing the ureter at risk. In order to manage these injuries one patient underwent open transureteroureterostomy repair while two had robotic ureteroureterostomy procedures. Their rate of ureteric injury here is consistent with other published series. The message from this paper is clear, ureteric injuries are not common. However, with meticulous preoperative planning, and an awareness of factors that are likely to make for a difficult dissection, ureteric injuries can be minimised.
Ureteric injury rates during robot assisted radical prostatectomy
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