JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 24, Number 11, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2014.0468
Letter to the Editor
Radical Robotic-Assisted Laparoscopic Prostatectomy: A Daycase Procedure Sanchia S. Goonewardene, MBChB (Hons.Clin.Sc.), BMedSc (Hons), Dip.SSc, PGCGC, MRCS (Ed and Eng),1 and Edward W. Rowe, MBBS, BSc, MRCS, FRCS (Urol) 2
Dear Editor:
T
he length of stay in our unit has been reduced following the move from open to radical robotic-assisted laparoscopic prostatectomy (RALP) in 2008, from 4 days to 1.2 days. Anecdotally, many patients appeared to be well enough to be discharged on the same day. It was shown that daycase laparoscopic prostatectomy is feasible by Roy et al.1 We therefore commissioned an audit to examine the need for medical intervention, within the first 24 hours following RALP, in order to ascertain its potential safety as a daycase procedure. One hundred consecutive patients were identified. A standard six-port transperitoneal technique, using the da Vinci S robot system (Intuitive Surgical, Sunnyvale, CA), was used in all patients. All men were monitored overnight as per our standard protocol. All complications were classified according to the Clavien–Dindo system.2,3 Any requirement for medical and nursing interventions was noted. Of the 100 patients, only 1 patient required medical review by a doctor within the 24 hours following his surgery. A second patient developed a low-grade temperature that settled without medical treatment. These were Clavien Grade 1 or 2. On each occasion, the problems were noted within 4 hours of surgery.
1 2
These audit data suggest that RALP could be safely performed as a daycase procedure. We plan to develop this further within our department (Fig. 1). References
1. Roy A, Dudderidge T, Hellawell G, et al. Introduction of 23 hour stay laparoscopic radical prostatectomy—A team effort [abstract]. BJU Int 2009;103(Suppl):7. 2. Clavien A, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518–526. 3. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Surgery 2004;240:205–213.
Guys Hospital, Kings College London, London, United Kingdom. Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom.
804
Address correspondence to: Edward W. Rowe, MBBS Department of Urology Bristol Urological Institute North Bristol NHS Trust Southmead Road Bristol BS10 5NB United Kingdom E-mail: [email protected]
LETTER TO THE EDITOR
805
FIG. 1. Protocol for daycase robotic-assisted laparoscopic prostatectomy (RALP). ASA, American Society for Anesthesiologists; BP, blood pressure; HR, heart rate; RR, respiratory rate.
Letter to the Editor
Radical Robotic-Assisted Laparoscopic Prostatectomy: A Daycase Procedure Sanchia S. Goonewardene, MBChB (Hons.Clin.Sc.), BMedSc (Hons), Dip.SSc, PGCGC, MRCS (Ed and Eng),1 and Edward W. Rowe, MBBS, BSc, MRCS, FRCS (Urol) 2
Dear Editor:
T
he length of stay in our unit has been reduced following the move from open to radical robotic-assisted laparoscopic prostatectomy (RALP) in 2008, from 4 days to 1.2 days. Anecdotally, many patients appeared to be well enough to be discharged on the same day. It was shown that daycase laparoscopic prostatectomy is feasible by Roy et al.1 We therefore commissioned an audit to examine the need for medical intervention, within the first 24 hours following RALP, in order to ascertain its potential safety as a daycase procedure. One hundred consecutive patients were identified. A standard six-port transperitoneal technique, using the da Vinci S robot system (Intuitive Surgical, Sunnyvale, CA), was used in all patients. All men were monitored overnight as per our standard protocol. All complications were classified according to the Clavien–Dindo system.2,3 Any requirement for medical and nursing interventions was noted. Of the 100 patients, only 1 patient required medical review by a doctor within the 24 hours following his surgery. A second patient developed a low-grade temperature that settled without medical treatment. These were Clavien Grade 1 or 2. On each occasion, the problems were noted within 4 hours of surgery.
1 2
These audit data suggest that RALP could be safely performed as a daycase procedure. We plan to develop this further within our department (Fig. 1). References
1. Roy A, Dudderidge T, Hellawell G, et al. Introduction of 23 hour stay laparoscopic radical prostatectomy—A team effort [abstract]. BJU Int 2009;103(Suppl):7. 2. Clavien A, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518–526. 3. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Surgery 2004;240:205–213.
Guys Hospital, Kings College London, London, United Kingdom. Bristol Urological Institute, North Bristol NHS Trust, Bristol, United Kingdom.
804
Address correspondence to: Edward W. Rowe, MBBS Department of Urology Bristol Urological Institute North Bristol NHS Trust Southmead Road Bristol BS10 5NB United Kingdom E-mail: [email protected]
LETTER TO THE EDITOR
805
FIG. 1. Protocol for daycase robotic-assisted laparoscopic prostatectomy (RALP). ASA, American Society for Anesthesiologists; BP, blood pressure; HR, heart rate; RR, respiratory rate.
