Tourinho-Barbosa Rafael Rocha, Tobias-Machado Marcos, Castro-Alfaro Adalberto, Ogaya-Pinies Gabriel, Cathelineau Xavier, Sanchez-Salas Rafael
Department of Urology, L'Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France.
Division of Urology, ABC Medical School, Sao Paulo, Brazil.
Arab J Urol. 2017 Dec 14;16(3):285-292. doi: 10.1016/j.aju.2017.11.005. eCollection 2018 Sep.
To review the main complications related to the robot-assisted laparoscopic (RAL) approach in urology and to suggest measures to avoid such issues.
A systematic search for articles of the contemporary literature was performed in PubMed database for complications in RAL urological procedures focused on positioning, access, and operative technique considerations. Each complication topic is followed by recommendations about how to avoid it.
In all, 40 of 253 articles were included in this analysis. Several complications in RAL procedures can be avoided if the surgical team follows some key steps. Adequate patient positioning must avoid skin, peripheral nerve, and muscles injuries, and ocular and cognitive complications mainly related to steep Trendelenburg positioning in pelvic procedures. Port-site access and closure should not be neglected during minimally invasive procedures as these complications although rare can be troublesome. Technique-related complications depend on surgeon experience and the early learning curve should be monitored.
Adequate patient selection, surgical positioning, mentorship training, and avoiding long-lasting procedures are essential to prevent RAL-related complications. The robotic surgical team must be careful and work together to avoid possible complications. This review offers several steps in surgical planning to reach this goal.
回顾泌尿外科机器人辅助腹腔镜（RAL）手术相关的主要并发症，并提出避免这些问题的措施。
在PubMed数据库中对当代文献进行系统检索，以查找RAL泌尿外科手术中与定位、入路和手术技术相关的并发症。每个并发症主题之后都有关于如何避免该并发症的建议。
本分析共纳入253篇文章中的40篇。如果手术团队遵循一些关键步骤，RAL手术中的几种并发症是可以避免的。适当的患者体位必须避免皮肤、周围神经和肌肉损伤，以及主要与盆腔手术中陡峭的头低脚高位相关的眼部和认知并发症。在微创手术过程中，不应忽视穿刺孔的入路和闭合，因为这些并发症虽然罕见，但可能会很麻烦。与技术相关的并发症取决于外科医生的经验，应监测早期学习曲线。
适当的患者选择、手术体位、导师培训以及避免长时间手术对于预防RAL相关并发症至关重要。机器人手术团队必须小心谨慎并协同工作以避免可能的并发症。本综述提供了手术规划中的几个步骤以实现这一目标。
