Laparoscopy and Robotics Surgery-related Complications in 1253 Robot-assisted and 485 Open Retropubic Radical Prostatectomies at the Karolinska University Hospital, Sweden Stefan Carlsson, Andreas E. Nilsson, Martin C. Schumacher, Martin N. Jonsson, Daniela S. Volz, Gunnar Steineck, and Peter N. Wiklund OBJECTIVES To quantify complications to surgery in patients treated with robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) at our institution. Radical prostatec- tomy is associated with specific complications that can affect outcome results in patients. METHODS Between January 2002 and August 2007, a series of 1738 consecutive patients underwent RARP (n = 1253) or RRP (n = 485) for clinically localized prostate cancer. Surgery-related compli- cations were assessed using a prospective hospital-based complication registry. The baseline characteristics of all patients were documented preoperatively. RESULTS Overall, 170 patients required blood transfusions (9.7%), 112 patients (23%) in the RRP group compared with 58 patients (4.8%) in the RARP group. Infectious complications occurred in 44 RRP patients (9%) compared with 18 (1%) in the RARP group. Bladder neck contracture was treated in 22 (4.5%) patients who had undergone RRP compared with 3 (0.2%) in the RARP group. Clavien grade IIIb-V complications were more common in RRP patients (n = 63; 12.9%) than in RARP patients (n = 46; 3.7%). CONCLUSIONS The introduction of RARP at our institution has resulted in decreased number of patients with Clavien grade IIIb-V complications, such as bladder neck contractures, a decrease in the number of patients who require blood transfusions, and decreased numbers of patients with postoperative wound infections. UROLOGY 75: 1092–1099, 2010. © 2010 Elsevier Inc. O nly some decades ago, retropubic radical prosta- tectomy (RRP) was considered a surgical proce- dure associated with significant morbidity. 1 The pioneering work by Walsh and Donker 2 that led to a better understanding of the anatomy of the prostate, and consequently to modification of surgical technique, has also made possible better hemostasis, improved visualiza- tion during dissection, and preservation of neurovascular bundles supplying corpora cavernosa. Since the introduc- tion of laparoscopic and later robot-assisted radical pros- tatectomy (RARP), numerous articles have been pub- lished comparing the outcome of these new techniques with the RRP. 3 To date, no clear differences regarding cancer control and functional results, such as continence and potency, have been reported between the minimally invasive techniques and RRP. Obviously, a man with a newly diagnosed prostate cancer appreciates the possibil- ity of being free from prostate cancer while also being able to avoid being affected by urinary leakage and erec- tile dysfunction after his radical prostatectomy. However, all complications from surgery must be considered when choosing treatment modalities, as they can affect the patient’s short- and long-term health as well as have economic consequences. The objective of the present study was to quantify complications to surgery in a con- secutive series of 1738 patients treated with open RRP and RARP for clinically localized prostate cancer. At our hospital we have performed RRP and RARP in parallel, using the same wards and surgical theaters. MATERIAL AND METHODS A total of 1738 men consecutively underwent a radical prosta- tectomy at Karolinska University Hospital in Solna, Stock- holm, between January 2002 and August 2007. We collected prospectively standard preoperative assessments including age, digital rectal examination, prostate specific antigen (PSA), Gleason score, clinical stage, and prostate volume. Nine sur- geons performed 485 RRP; 6 of these surgeons (I-VI) also The study was supported by grants provided from the Swedish Cancer Society (4598- B01-01XAC), ALF (founding of clinical research by Stockholm County Council), and the Johanna Hagstrand and Sigfrid Linnér Foundation. From the Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; and Division of Clinical Cancer Epidemiol- ogy, Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden Reprint requests: Stefan Carlsson, M.D., Ph.D., Department of Urology, Karolin- ska Hospital, 171 76 Stockholm, Sweden. E-mail: stefan.karlsson@karolinska.se Submitted: March 7, 2009, accepted (with revisions): September 2, 2009 1092 © 2010 Elsevier Inc. 0090-4295/10/$34.00 All Rights Reserved doi:10.1016/j.urology.2009.09.075