Common complications in robotic urological surgery
Expert panelists presented their misfires in surgery to help you fine-tune your technique.
While generally safe, robotic urological surgery can be associated with a wide range of intraoperative complications that can threaten to rattle even the most experienced surgeons.
The first rule of thumb: “Never feel ashamed to ask for help. It’s a sign of strength,” said Rene Sotelo, MD, MDMM, professor of clinical urology at USC Institute of Urology and director of the USC Department of International Medicine and co-author of Complications in Robotic Urologic Surgery.
It's also helpful to be aware of the potential complications and best practices for avoiding them. During Monday’s Instructional Course,* “Complications of Robotic Urological Surgery: Prevention, Recognition and Management,” Dr. Sotelo moderated an expert panel of urologic robotic surgeons who discussed the nuances of robotic-assisted urologic surgery, including complications they’ve encountered with patients on the table, the technical mistakes they’ve made, how they corrected them and the lessons they learned to help you avoid them.
Panelists included David Canes, MD, associate professor of urology at Tufts School of Medicine and senior staff surgeon at Lahey Hospital & Medical Center, Mihir Desai, MD, MPH, director of robotic surgery at the USC Institute of Urology and professor of clinical urology at USC, and Michael Stifelman, MD, professor and chair of urology at Hackensack Meridian School of Medicine. Here's a snapshot of some of their key takeaways for robotic-assisted urologic surgery:
- Use Cadiere forceps to avoid injuries to the small bowel during preparation and anastomosis.
- For organ-sparing female cystectomies, it is important to recognize the correct plane between the vagina and rectum to avoid inadvertent injuries. When unrecognized, this will undoubtedly lead to open or laparoscopic exploration.
- Assess for the location of the ureter and other nearby structures prior to stapling the bowel to avoid accidental injury.
- Prevention is key. Treat the duodenum with kid gloves to avoid surgical complications.
- You control the mood and the anxiety in the room. When the wheels come off, regain control to avoid cascading complications.
The session included video presentations from actual surgeries demonstrating trocar placement and other urological surgery techniques. Overall, although robotic surgery can offer enhanced visualization of the operating field, keep the big picture in mind to avoid complications. “It’s always important to have an awareness beyond the surgical field you’re working in,” Dr. Stifelman said.
*Accessible with the Instructional Course Pass.
