Abstract
Robot-assisted radical prostatectomy remains a favorable treatment option for locally advanced prostate cancer in patients with obstructive lower urinary tract symptoms. However, the steep Trendelenburg lithotomy position required for this procedure can result in serious complications, particularly in patients with obesity. Here, the case of a 66-year-old man with obesity (BMI, 35 kg/m2), insulin-dependent diabetes mellitus, and multiple comorbidities is reported, who underwent robot-assisted radical prostatectomy (console time, approximately 4 h) for clinically staged cT3a cN1 prostate cancer. Immediately after surgery, the patient developed severe gluteal pain, sensorimotor deficits, and massive rhabdomyolysis, resulting in anuric acute kidney injury and respiratory insufficiency. The clinical course was further complicated by heparin-induced thrombocytopenia type II and a grade IV gluteal pressure ulcer. A 22-day intensive care stay was required, including continuous hemodiafiltration and transfusion of 12 units of erythrocytes. With multidisciplinary management, renal function partially recovered, and the patient was discharged with minimal residual neuropathic deficits. This case highlights the importance of comprehensive preoperative risk assessment and provides clinically relevant insights into the recognition and multidisciplinary management of severe complications associated with prolonged positioning during robot-assisted radical prostatectomy.