Characteristic Findings in Aborted Robot-Assisted Radical Prostatectomies

<b><i>Background:</i></b> In rare instances, patients deemed operative candidates for robot-assisted radical prostatectomy (RARP) have their procedure aborted intraoperatively. Understanding the incidence and factors associated with aborted RARP cases can improve preoperative counseling and intraoperative decision-making. We performed a retrospective analysis of RARP cases performed by high-volume surgeons across our multihospital medical system to characterize the incidence and causes of aborted procedures. <b><i>Methods:</i></b> We queried the Northwestern Electronic Data Warehouse from January 2018 to June 2024 for patients who underwent RARP performed by high-volume surgeons. Aborted procedures were defined as those terminated after anesthesia but before completion. Comparative statistics were used to evaluate clinical, radiologic, and pathologic characteristics between aborted and completed cases. Imaging features of propensity-matched patients with completed or aborted procedures were also analyzed. <b><i>Results:</i></b> Among 3316 RARPs performed by 10 high-volume surgeons, 26 cases (0.7%) were aborted. The leading causes were pelvic lipomatosis (35%), adhesions (27%), and cardiorespiratory events (12%). Higher body mass index (BMI) was significantly associated with aborted operation (30.7 <i>vs</i> 27.8, <i>p</i> = 0.015). Although prior abdominal operations were more frequent in the aborted group (7.7% <i>vs</i> 2.6%), this was not statistically significant (<i>p</i> = 0.2). Perioperative complications occurred in 12% of aborted cases. Four cases were reattempted, with three completed effectively. The apparent diffusion coefficient of perivesical pelvic fat was higher in aborted cases but not statistically significant (<i>p</i> = 0.13). <b><i>Conclusions:</i></b> The incidence of aborted RARP among experienced surgeons is low, accounting for less than 1% of all cases. Pelvic lipomatosis was the most common reason for an aborted procedure and may be recognized preoperatively on imaging. Higher BMI was associated with a significantly higher risk for aborted procedure. When counseling patients, this information could be used to set expectations for the risk of an aborted procedure.