1
|
Regis L, Bertholle J, Planas J, Lozano F, Lorente D, Celma A, Cuadras M, Costa M, Morote J, Trilla E. State of art of robotic prostatectomy: the way we do it in Catalonia, Spain. Actas Urol Esp 2024; 48:581-587. [PMID: 38740264 DOI: 10.1016/j.acuroe.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/28/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION AND OBJECTIVE Robotic-assisted laparoscopic prostatectomy (PLAR) seems to improve functional outcomes, however there is not a consensus of a standard procedure. The aim of this study was to identify the PLAR "state of art" in Catalonia, Spain. MATERIAL AND METHODS This was a cross-sectional survey-based study conducted among urologists across Catalonia, Spain. The survey was distributed through online platforms and the professional urology society. All statistical analyses were performed using Stata software, v20. RESULTS 59 urologists completed the survey, revealing PLAR as the most commonly used technique (79.7%). Most urologist (70%) create the pneumoperitoneum using a controlled incision with direct access and 78.3% use the Airseal technology. The intraperitoneal approach is performed in >90% of cases. Endopelvic fascia preservation is not routinely performed. 34.5% of the survey not perform the dorsal vein complex suture. All preserves the bladder neck when oncologically safe. Nerve-vascular bundles bleeding control is performed using standard coagulation or suturing. 34% performed posterior reconstruction. Only use hemostatic devices when evident bleeding and 70% does not routinely left a drainage. Multivariable analysis showed that center volume had a significant independent association with dorsal venous complex suturing (OR 0.073, 95%CI 0.07-0.826), nerve-vascular bundles suturing hemostasis (OR 11.67, 95%CI 1.07-127.60) and endopelvic fascia preservation (OR 13.64, 95%CI 1.087-201.27), but there was no correlation with time the bladder catheter or days hospitalized. CONCLUSIONS The study provides an overview of the state of PLAR in Catalonia, Spain, showing significant variability and reflecting a commitment to advancing surgical technology and patient care.
Collapse
Affiliation(s)
- L Regis
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - J Bertholle
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - J Planas
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - F Lozano
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - D Lorente
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - A Celma
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - M Cuadras
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - M Costa
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - J Morote
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - E Trilla
- Servicio de Urología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Sección de Oncología, Sociedad Catalana de Urología (SCU), Barcelona, Spain; Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
2
|
Vangheluwe L, Legeay M, Surlemont L, Dupuis H, Defortescu G, Cornu JN, Pfister C. Clinical impact of an enhanced recovery protocol implementation for nephrectomy and radical prostatectomy. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102674. [PMID: 38944244 DOI: 10.1016/j.fjurol.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) is a combination of multimodal pathways to improve surgical outcomes. Recommendations for radical cystectomy have been published by the ERAS society for the cystectomy but a lack of evidence is observed for urological procedures such as nephrectomy (Ne) and radical prostatectomy (RP). The aim of our study was to evaluate the impact of enhanced recovery protocol implementation for Ne ad RP at our academic institution. METHODS We performed a retrospective, monocentric, comparative analysis, pre and post implementation of an enhanced recovery protocol for patients undergoing robotic-assisted radical prostatectomy or nephrectomy (partial or total) for cancer. The primary endpoint was the mean length of stay (LOS). Secondary endpoints included 30-days readmission, postoperative complications, 90 days survival, and oncologic outcome at 6 months. RESULTS We included 264 patients between January, 2019, and December, 2020. Statistical analysis was performed separately by type of surgery. The LOS of patients included in the ERP protocol was decreased on average by 1.3 days IC95% [-2.50; -0.08], P<0.001 for nephrectomies and by 2.2 days IC95% [-3.72; -0.62] P<0.001 for prostatectomies, compared to non-ERP patients. There were no more re-admission, death or oncologic recurrence. CONCLUSION In our experience, ERP for oncological nephrectomy and prostatectomy reduced the length of stay, without increasing postoperative complications and readmission. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Lucie Vangheluwe
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France.
| | - Mathilde Legeay
- Service d'anesthésie réanimation, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Louis Surlemont
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Hugo Dupuis
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | | | - Jean Nicolas Cornu
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| | - Christian Pfister
- Service d'urologie, CHU de Rouen, hôpital Charles Nicolle, Rouen, France
| |
Collapse
|
3
|
Hallengren S, Schening A, Lindström AC, Radros J, Eriksson J, Blomqvist E, Knutas R, Fällman N, Aly M, Gupta A. Postoperative pain, recovery and discharge after robot-assisted laparoscopic prostatectomy: A multicentre, single blinded, randomised controlled trial. Acta Anaesthesiol Scand 2024; 68:1006-1015. [PMID: 38828497 DOI: 10.1111/aas.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/09/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND General anaesthesia is standard of care for patients undergoing robot assisted laparoscopic prostatectomy (RALP). However, postoperative pain and bladder discomfort remains an issue, and optimising pain management could improve recovery and promote earlier home discharge. The main objective of this trial was to evaluate if patients receiving spinal anaesthesia are more frequently home ready at 8 pm on the same day compared with multimodal pain management following RALP under general anaesthesia. METHODS This pragmatic, randomised controlled, multicentre trial was performed between January 2019 to December 2021. Patients undergoing RALP under general anaesthesia were randomised to either multimodal analgesia using parecoxib and morphine intra-operatively (Group GM) or spinal anaesthesia with bupivacaine and sufentanil (Group GS). The primary aim, home readiness, was assessed using a post-anaesthesia discharge scoring system. RESULTS Of 202 patients analysed, 27% patients reached home readiness criteria after 12 h, 46% after 24 h and 79% after 48 h, without differences between the groups. Urge to pass urine was greater in group GM than in group GS (p ⟨0.001) and lasted for a median of two hours in both groups. More patients expressed satisfaction with postoperative care in group GS (p ⟨0.001). No other significant differences were found between the groups. DISCUSSION We found no difference in time to home readiness between the groups. Approximately one-fourth of the patients achieved home readiness the same day after surgery without difference between the groups. Fewer patients had urge, and patient satisfaction was greater in group GS.
Collapse
Affiliation(s)
- S Hallengren
- Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
| | - A Schening
- Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
| | - A-C Lindström
- Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Institution for Pharmacology and Physiology, Karolinska Institute, Stockholm, Sweden
| | - J Radros
- Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - J Eriksson
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - E Blomqvist
- Department of Urology, Capio Saint Görans Hospital, Stockholm, Sweden
| | - R Knutas
- Department of Urology, Capio Saint Görans Hospital, Stockholm, Sweden
| | - N Fällman
- Karolinska University Hospital, Stockholm, Sweden
| | - M Aly
- Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Institution for Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - A Gupta
- Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
- Institution for Pharmacology and Physiology, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
4
|
d'Agate D, Martini A, Lesourd M, Tollon C, Loison G, Almeras C, Pradère B, Salin A, Beauval JB, Ploussard G. Patient experience and satisfaction after same-day discharge radical prostatectomy using a personalized, digital perioperative programme. World J Urol 2024; 42:378. [PMID: 38888646 PMCID: PMC11189318 DOI: 10.1007/s00345-024-05099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE To assess the patient experience and satisfaction after the implementation in routine of a personalized, digital programme before and after same-day discharge (SDD) robot-assisted radical prostatectomy (RARP). METHODS The study is a pre/post-interventional, multi-surgeon, unicentre, prospective study. All consecutive patients undergoing SDD RARP were included during a 6-month period. After a pre-interventional assessment of the satisfaction rate (n = 26), all patients (n = 46) were introduced to the Betty. Care platform and followed the BETTY COACHING programme which included a specific radical prostatectomy module. The primary endpoint was patient satisfaction 6 weeks after SDD RARP. Secondary endpoints were hospital stay, readmission and complications rates, unplanned visits, and remote monitoring data. RESULTS Median age and PSA were 66 years and 7.0 ng/ml. Lymph node-dissection and nerve-sparing procedures were performed in 41.3 and 87.0% of patients, respectively. Median operative time and blood loss were 80 min and 150 ml, respectively. The 90-day rates of unplanned visits, readmission and complications were improved after the digital tool implementation (2.2, 2.2, and 8.7%, respectively). Mean satisfaction score was 9.6 out of 10 (8.0 before implementation). Median duration of pain was 2 days after discharge, with median pain intensity of 2/10. Median duration of daily active use of remote monitoring was 34 days. The urinary continence rate was 91.3% 6 weeks after surgery in the postinterventional cohort. CONCLUSIONS The implementation of a personalized, surgery-specific, digital programme combining prehabilitation, patient education, rehabilitation, patient-reported outcome measurement and remote monitoring, improves patient experience and satisfaction and could help promoting early discharge even after a major surgery.
Collapse
Affiliation(s)
- Daniele d'Agate
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
- Department of Surgical Sciences-Urology, Città Della Salute E Della Scienza Di Torino, Molinette Hospital, University of Turin, 10126, Turin, Italy
| | - Alberto Martini
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Marine Lesourd
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Christophe Almeras
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Benjamin Pradère
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Jean-Baptiste Beauval
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France
| | - Guillaume Ploussard
- Urology Department, La Croix du Sud Hospital, 52b, Chemin de Ribaute, 31130, Quint Fonsegrives, France.
| |
Collapse
|
5
|
Rosen DC, Drescher MR, Arias Villela NL, Abbott JE, Dunne MM, Davalos JG. Advancements in Performance of Percutaneous Nephrolithotomy in Ambulatory Surgery Centers: Outcomes and Lessons From 1250+ Cases. Urology 2024; 184:26-31. [PMID: 38048915 DOI: 10.1016/j.urology.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of routine ambulatory percutaneous nephrolithotomy (PCNL) in a freestanding ambulatory surgical center. METHODS Patients were treated between 2015 and 2022 by one of three experienced endourologists in Maryland. The surgery center is free-standing, with the nearest hospital approximately 10 minutes away. Patient characteristics and surgical datapoints, including need for transfer, were gathered prospectively at the time of surgery. Subset analyses were performed in patients with staghorn calculi or elevated body mass index, as they represent higher-risk populations. RESULTS A total of 1267 patients underwent ambulatory PCNL with a median stone diameter of 32 mm. The average recovery time was 87 minutes, with 1.7% of patients requiring transfer to the hospital, generally for postoperative hypotension or inadequate pain control. 166 patients with body mass index >40 were safely treated, with no significant difference in transfer rate (P = .5). 2.8% of patients had a complication, with the majority being Clavien-Dindo grade I or II. 88 patients with staghorn calculi were treated, with a 6% transfer rate. Staghorn calculi were the only factor found on multivariable analysis to be a significant predictor of transfer (OR 3.56 (1.17-10.82) P < .05). CONCLUSION Ambulatory PCNL may safely be performed in a surgery center in most patients. These outcomes reflect the real-world experience of high-volume surgeons and demonstrate a multiyear paradigm shift in PCNL from an inpatient procedure to an outpatient procedure in a surgery center.
Collapse
Affiliation(s)
| | - Max R Drescher
- Department of Urology, University of Maryland, Baltimore, MD
| | | | | | | | | |
Collapse
|
6
|
Silver JK, Flores LE. Integrating Prehabilitation into the Cancer Survivorship Framework. Eur Urol Focus 2024; 10:23-25. [PMID: 37996272 DOI: 10.1016/j.euf.2023.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
Collapse
Affiliation(s)
- Julie K Silver
- Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
7
|
Broe M, Carbin Joseph DD, Casson H, Innes M, Adamou C, Fragkoulis G, Moschonas D, Kusuma VRM, Hicks J, Patil K, Perry MJA, Abou Chedid W. Assessment of routine same-day discharge surgery for robot-assisted radical prostatectomy. World J Urol 2023; 41:2679-2684. [PMID: 37668719 DOI: 10.1007/s00345-023-04566-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION It is important for robotic surgery to be cost-effective, especially by reducing the length of stay (LOS). Therefore, we developed a protocol for day-case robot-assisted radical prostatectomy (RARP). This study aimed to validate this as a safe practice of care and to assess the potential benefits to the hospital and patient. METHODS In this single-centre study, all patients booked for RARP between April 2022 and October 2022 were screened for suitability for day case. All tumour types were included. Exclusion criteria were a history of complex abdominal surgeries, salvage prostatectomy, body mass index (BMI) > 35 and patient living alone or > 150 km away from the hospital. All day-case RARPs were performed as a morning case with a protocol for review throughout the day with evening discharge if mobilising independently and eating/drinking well. The primary outcome of the study was success rate of discharge home on day of surgery (DOS) with secondary outcomes of readmissions and complications. A patient questionnaire was completed at home including both visual analogue scale (VAS) for pain and satisfaction rating. RESULTS Forty-five patients underwent day-case RARP over a 6-month period with minimum of 30 days of follow-up. 41/45 (91%) had successful DOS discharge home. The four admissions overnight were due to dizziness, low oxygen saturation, intraoperative complications and a diagnosis of COVID-19. There were no readmissions and no 30-day complications. The most common issues at home were catheter discomfort and constipation with low mean VAS pain score and low nausea reported. The overall patient satisfaction rating was very high at 4.8/5, and 97% said they would recommend to a family member. The cost saving for the hospital was 400 pounds per patient. CONCLUSION Day-case procedure is a viable, safe and efficient pathway for appropriately selected and counselled patients undergoing RARP.
Collapse
Affiliation(s)
- Mark Broe
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | | | - Helen Casson
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Maria Innes
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Constantinos Adamou
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Gerasimos Fragkoulis
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Dimitrios Moschonas
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Venkata Ramana Murthy Kusuma
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - James Hicks
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Krishna Patil
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Matthew James Alexander Perry
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| | - Wissam Abou Chedid
- Department of Urology, Stokes Centre for Urology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
| |
Collapse
|
8
|
Broch A, Paye-Jaouen A, Bruneau B, Glenisson M, Taghavi K, Botto N, Goulin J, Lopez P, Querciagrossa S, El Ghoneimi A, Dahmani S, Hidalgo M, Blanc T. Day Surgery in Children Undergoing Retroperitoneal Robot-assisted Laparoscopic Pyeloplasty: Is It Safe and Feasible? EUR UROL SUPPL 2023; 51:55-61. [PMID: 37187722 PMCID: PMC10175732 DOI: 10.1016/j.euros.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Background Robot-assisted pyeloplasty is the most frequently performed robotic procedure in children. A retroperitoneal approach limits surgical trauma and avoids peritoneal irritation. This led to the establishment of the criteria for day surgery (DS) and a related clinical care pathway. Objective To assess the feasibility and safety of DS in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty (R-RALP). Design setting and participants We performed a bicentric prospective study (NCT03274050) over 2 yr involving the two major paediatric urology teaching hospitals in Paris. A clinical pathway and a prospective research protocol were specifically established. Intervention DS in selected children undergoing R-RALP. Outcome measurements and statistical analysis The primary outcomes were DS failure, 30-d complications, and readmission rates. The secondary outcomes included preoperative characteristics, perioperative parameters, and surgical outcomes. Quantitative variables were expressed as medians with interquartile ranges. Results and limitations Thirty-two children fulfilled specific inclusion criteria and were consecutively selected for DS following R-RALP. The median patient age was 7.6 yr (4.1-11.8) and weight 25 kg (14-45). The median console time was 137 min (108-167). There were no intraoperative complications or conversions. Six children were kept under observation overnight and discharged the following day due to persistent pain (n = 3), parental anxiety (n = 2), or a prolonged procedure (n = 1). The median duration of hospital stay of the 26 children in the DS setting was 12.7 h (12.2-13.2). During the 30-d period, there were four emergency room visits (15%) resulting in two patients requiring readmission (8%): one for febrile urinary tract infection (Clavien-Dindo II) and one child with no JJ stent for urinoma (Clavien-Dindo IIIb). Radiological studies confirmed improvement in dilatation for all cases with no recurrence (median follow-up: 15 mo). Conclusions This prospective case series is the first to demonstrate the feasibility and safety of DS in children undergoing R-RALP, obviating the need for routine inpatient care. Excellent results can be achieved by careful patient selection, a clear clinical pathway, and a dedicated team. Further evaluation is warranted to assess the cost effectiveness. Patient summary This study shows that day surgery after robotic pyeloplasty is both safe and effective in selected children.
Collapse
|
9
|
Short-Term Patient Outcomes After Implementation of Robotic-Assisted Radical Prostatectomy Under Opioid Free Anesthesia at an Ambulatory Surgery Center. J Perianesth Nurs 2023; 38:488-492. [PMID: 36599789 DOI: 10.1016/j.jopan.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Opioid free anesthesia (OFA) is associated with decreased risk of PONV and need for rescue analgesia, making it ideal for patients anticipating same-day discharge. The purpose of this project was to describe the perioperative care and short-term outcomes for patients undergoing robotic-assisted radical prostatectomy (RARP) under OFA at an ambulatory surgical center (ASC). DESIGN A retrospective descriptive design was used to examine the perioperative care and short-term outcomes of patients undergoing RARP under OFA at an ASC. METHODS The records of all sequential patients undergoing RARP over an 18-month period were reviewed. Data collected included patient comorbidities, surgical procedures, medications administered, verbal numeric rating scale (VNRS) for pain scores, times to oral intake, ambulation, and discharge, patient disposition, and unplanned return to the ER or hospital within 30 days. FINDINGS Data were extracted from 54 sequential records. Median VNRS scores were zero throughout PACU stay. Fifty-three patients (98.1%) were successfully discharged home, with an average postoperative stay of 250.8 (SD 35.0) minutes. There were no complaints of post-discharge nausea and vomiting or intractable pain at 72 hours after surgery. One patient was transferred to the hospital and two patients returned to the emergency room within 30 days. CONCLUSIONS Although generalizability is limited, these results suggest that carefully selected patients can be discharged home after RARP under a balanced OFA technique. Innovative practices are needed to address the current backlog of patients needing non-emergent surgery. Discharge home avoids the increase in resource consumption and infection risk associated with hospital admission.
Collapse
|
10
|
Ambulatory anesthesia and discharge: an update around guidelines and trends. Curr Opin Anaesthesiol 2022; 35:691-697. [PMID: 36194149 DOI: 10.1097/aco.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Provide an oversight of recent changes in same-day discharge (SDD) of patient following surgery/anesthesia. RECENT FINDINGS Enhanced recovery after surgery pathways in combination with less invasive surgical techniques have dramatically changed perioperative care. Preparing and optimizing patients preoperatively, minimizing surgical trauma, using fast-acting anesthetics as well as multimodal opioid-sparing analgesia regime and liberal prophylaxis against postoperative nausea and vomiting are basic cornerstones. The scope being to maintain physiology and minimize the impact on homeostasis and subsequently hasten and improve recovery. SUMMARY The increasing adoption of enhanced protocols, including the entire perioperative care bundle, in combination with increased use of minimally invasive surgical techniques have shortened hospital stay. More intermediate procedures are today transferred to ambulatory pathways; SDD or overnight stay only. The traditional scores for assessing discharge eligibility are however still valid. Stable vital signs, awake and oriented, able to ambulate with acceptable pain, and postoperative nausea and vomiting are always needed. Drinking and voiding must be acknowledged but mandatory. Escort and someone at home the first night following surgery are strongly recommended. Explicit information around postoperative care and how to contact healthcare in case of need, as well as a follow-up call day after surgery, are likewise of importance. Mobile apps and remote monitoring are techniques increasingly used to improve postoperative follow-up.
Collapse
|
11
|
Kassouf W, Ploussard G. Improved recovery after uro-oncology surgery: the critical role of pre- and re-habilitation. World J Urol 2022; 40:1287. [PMID: 35590010 DOI: 10.1007/s00345-022-04034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Wassim Kassouf
- Division of Urology, McGill University, Montreal, Canada.
| | | |
Collapse
|