Introduction: Rectal injury is a potential devastating complication in radical prostatectomy. We reviewed the incidence and management of rectal injuries with robotic-assisted laparoscopic radical prostatectomy performed by a single surgeon. Of the first 251 robotic-assisted laparoscopic radical prostatectomies performed, 2 (0.8%) were complicated by rectal injury.
Technical considerations: All patients underwent bowel preparation and received preoperative intravenous antibiotics. Both rectal injuries were detected intraoperatively and treated robotically. The rectotomy was closed in two layers of absorbable sutures and imbricated with a nonabsorbable suture. The rectum was then tacked to the levator fibers on one side with nonabsorbable suture to pull the injury away from the vesicourethral anastomosis. An omental flap was developed and tacked posterior to the urethra to cover the repair. A closed suction drain was placed. After surgery, the patients received broad-spectrum intravenous antibiotics and resumed oral intake on postoperative day 1. At 2 weeks, the Foley catheter was removed after voiding cystourethrography confirmed no extravasation.
Conclusions: Rectal injury during robotic-assisted laparoscopic radical prostatectomy can be identified and managed intraoperatively without requiring open conversion. A three-layer closure tacked away from the vesicourethral anastomosis and reinforced by an omental flap resulted in an uneventful recovery.