Ligating clip migration after robot-assisted laparoscopic radical prostatectomy: a single-center experience

Background: Ligating clip migration (LCM) after robot-assisted laparoscopic radical prostatectomy (RARP) is a rare but troublesome complication, that may result in calculus formation, bladder neck contracture, and anastomotic stricture. Herein, we describe our experiences with LCM after RARP and explore its risk factors, potential pathogenesis, and preventive measures. Methods: We retrospectively reviewed patients who underwent RARP at our medical center between December 2015 and June 2019, identifying individuals with LCM. Clinical and surgical data were collected from these patients. Results: Of the 682 patients who underwent RARP at our institution, 26 (3.8%) had LCM. The duration from RARP to the identification of LCM ranged from 1 to 37 (13 +/- 10) months. Clips migrated into the urethrovesical anastomosis in 22 patients (84%), prompting cytoscopic extraction to remove the migrated clips. The length of stay after RARP was longer in LCM-positive patients than in LCM-negative patients (13.5 vs. 9.4 days, P=0.034). Additionally, the rates of urine leakage (15% vs. 6%, P=0.046) and anastomotic stenosis (54% vs. 5%, P=0.000) were higher among LCM-positive patients. More positive urethra/apex margins were found in LCM-positive patients (38% vs. 21%, P=0.039). Conclusions: The incidence of clip migration after RARP may not be as low as previously thought. Cystoscopy is recommended in post-RARP patients with recurrent lower urinary tract symptoms (LUTS) and/or urinary retention. Prolonged length of stay after the first RARP, urine leakage, anastomotic stenosis, and positive urethra/apex margin might be predictors of LCM. We recommend reduced ligating clip usage and electrotome near the urethrovesical anastomosis to reduce clip migration incidence. Meanwhile, more researches are needed to determine the practicality of reducing the risk of clip migration after RARP.