Day-case robotic assisted laparoscopic prostatectomy (RALP)

Abstract

Objectives: RALP is considered by many the gold standard surgical treatment for localised prostate cancer. We came from a unit offering enhanced recovery for open radical prostatectomy with discharge after an overnight stay in 80% of cases. We have introduced an enhanced recovery programme for our RALP patients allowing safe discharge as a day case procedure whilst maintaining oncological outcomes. Methods: Following initial data collection and patient feedback we observed the potential to undertake select cases as day cases. These all adhere to local guidelines for day case selection and RALP surgical suitability. We developed a bespoke multidisciplinary ERAS programme and each patient was assigned a urology nurse specialist key worker as their point of contact. They were pre-assessed and given a detailed patient information booklet on RALP and our ERAS programme. Results: We have operated on 88 cases with intention of day of surgery discharge. The median age was 62.5, median console time was 89.5 minutes and median blood loss was 112.5mls. 82/88 (93%) patients were successfully discharged on the same day of surgery. Median length of hospital stay was 11 hours. 6/88 patients remained in hospital overnight, 5 were discharged the following morning and the remaining patient suffered a port site bleed requiring blood transfusion and a longer stay. All patients were followed up at day 1 post operatively by telephone consultation and reported their pain as being well controlled, and 100% satisfaction. Conclusion: Implementing an ERAS programme has allowed RALP to be undertaken as a day case procedure and we believe we are the first to have reported this experience. We undertook a series of simplifications to our peri-operative process. Specific focus on patient positioning, multimodal analgesia and removal of long acting opiates, with diligent local anaesthetic infiltration to port sites and bladder. This represented a radical shift from our previous standard operating procedure. Having a motivated and like-minded team was essential, with inclusion of recovery and ward staff in patient planning. Patient education is also vital to success and having in place a robust and continuous method of auditing results key. We cannot claim non-inferiority as yet, but our results are comparable to non day case RALP. Disclosure of Interest: None declared.