Background: Intraoperative complications (ICs) are invariably underreported in urological surgery despite the recent endorsement of new classification systems. We aimed to provide a detailed overview of ICs during Retzius-sparing robot-assisted radical prostatectomy (RS-RARP). Methods: We prospectively collected data from 1891 patients who underwent RS-RARP at a single high-volume European center from January 2010 to December 2022. ICs were collected based on surgery reports and categorized according to the Intraoperative Adverse Incident Classification (EAUiaiC). The quality criteria for accurate and comprehensive reporting of intraoperative adverse events proposed by the Intraoperative Complications Assessment and Reporting with Universal Standards (ICARUS) Global Surgical Collaboration Project were fulfilled. To better classify the role of the RS-RARP approach, ICs were classified into anesthesiologic and surgical ICs. Surgical ICs were further divided according to the timing of the complication in RARP-related ICs and ePNLD-related ICs. Results: Overall, 40 ICs were reported in 40 patients (2.1%). Ten out of thirteen ICARUS criteria were satisfied. According to EAUiaiC grading of ICs, 27 (67.5%), 7 (17.5%), 2 (5%), 2 (5%), and 2 (5%) patients experienced Grade 1, 2, 3, 4A, and 4B, respectively. When we classified the ICs, two cases (5%) were classified as anesthesiologic ICs. Among the 38 surgical ICs, 16 (42%) were ePNLD-related, and 22 (58%) were RARP-related. ICs led to seven (0.37%) post-operative sequelae (four non-permanent and three permanent). Patients who suffered ICs were significantly older (67 years vs. 65 years,p= 0.02) and had a higher median BMI (27.0 vs. 26.1,p= 0.01), but did not differ in terms of comorbidities or tumor characteristics (allpvalues ≥ 0.05). Conclusions: Intraoperative complications during RS-RARP are relatively infrequent, but should not be underestimated. Patients suffering from ICs are older, have a higher body mass index, a higher rate of intraoperative blood transfusion, and a longer length of stay.
背景：尽管近期已认可新的分类系统，泌尿外科手术中术中并发症的报告仍普遍不足。本研究旨在详细概述保留Retzius间隙机器人辅助根治性前列腺切除术中的术中并发症情况。方法：我们前瞻性收集了2010年1月至2022年12月期间在欧洲某大型医疗中心接受RS-RARP的1891例患者数据。术中并发症依据手术记录采集，并按照欧洲泌尿外科协会术中不良事件分类标准进行分级。研究同时满足了ICARUS全球外科合作项目提出的术中不良事件准确全面报告质量要求。为更好评估RS-RARP术式特点，将术中并发症分为麻醉相关与手术相关两类，其中手术相关并发症根据发生时机进一步划分为RARP相关并发症与扩大盆腔淋巴结清扫相关并发症。结果：共40例患者报告术中并发症（发生率2.1%），13项ICARUS标准中有10项达标。按EAUiaiC分级标准：1级27例（67.5%）、2级7例（17.5%）、3级2例（5%）、4A级2例（5%）、4B级2例（5%）。分类分析显示麻醉相关并发症2例（5%）；38例手术相关并发症中，扩大盆腔淋巴结清扫相关16例（42%），RARP相关22例（58%）。术中并发症导致7例（0.37%）术后后遗症（4例暂时性、3例永久性）。发生并发症的患者年龄显著更高（67岁 vs 65岁，p=0.02），体重指数中位数更高（27.0 vs 26.1，p=0.01），但合并症与肿瘤特征无统计学差异（所有p值≥0.05）。结论：RS-RARP术中并发症发生率相对较低，但不应被低估。发生并发症的患者具有年龄更大、体重指数更高、术中输血率更高及住院时间更长的特征。
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