The study was not powered to demonstrate which laparoscopic procedures were associated with the greatest risk of VTE or hemorrhagic complications.81 In a large, multicenter study of 5951 LY2109761 purchase patients undergoing traditional laparoscopic and robot-assisted

laparoscopic prostatectomy, the rates of DVT and PE were 0.5% and 0.2%, respectively. Univariate Inhibitors,research,lifescience,medical analyses revealed history of DVT, current tobacco smoking, re-exploration, increased operating room time, longer hospital stay, and prostate volume > 100 cc to be associated with increased risk of VTE. Sixty-seven percent of patients received perioperative heparin. The use of preoperative heparin prophylaxis was associated with increased intraoperative estimated blood loss (300 vs 200 cc), longer hospital stay (3 vs 2 days), higher transfusion rates (4.2% vs 3.1%), and higher reoperation rates (1.6% vs 0.8%).82 Taken together,

these 2 studies do not support the use of pharmacologic thromboprophylaxis Inhibitors,research,lifescience,medical in laparoscopic urologic surgery. However, specific laparoscopic procedures need to be examined in appropriately powered, Inhibitors,research,lifescience,medical prospective, randomized, controlled studies to definitively evaluate the safety and efficacy of pharmacologic thromboprophylaxis in laparoscopy. Patients still must be considered on an individual basis with appropriate measures being taken to minimize chances of VTE in high-risk patients. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Inhibitors,research,lifescience,medical therapy did not recommend routine pharmacologic thromboprophylaxis in

patients undergoing laparoscopic surgery unless patients have additional risk factors for VTE, in which case any combination of LDUH, LMWH, IPC, or GPS is appropriate.10 Inhibitors,research,lifescience,medical The AUA Best Practice Statement confirmed these recommendations for this patient population.57 Lithotomy Position In a review of 177 surgeries performed in the lithotomy position, the authors reported 4 cases (2.3%) of VTE. There were 3 cases of PE and 1 case of DVT. Of note, these patients had undergone urethral reconstruction and were placed on bedrest for 4 to 5 days postoperatively. Therefore, it is unclear if VTE was a function of operative positioning or lack of ambulation postoperatively.83 Timing of VTE VTE has traditionally been considered a complication that occurs in the immediate postoperative period. However, recent studies have demonstrated that VTE often occurs after the many immediate postoperative period. In many cases, VTE was diagnosed after the patient was discharged from the inpatient stay. As discussed, Leibovitch and colleagues found that 7 of the 9 patients who developed DVT after radical retropubic prostatectomy did so after discharge.74 Dillioglugil and associates reported that 5 cases of symptomatic PE occurring after radical retropubic prostatectomy were diagnosed between 7 and 24 days postoperatively.