Comparing the experience of enhanced recovery programme for gynaecological patients undergoing laparoscopic versus open gynaecological surgery: a prospective study

Abstract

BackgroundEnhanced recovery has been shown to improve patients’ experience after surgery. There are no previous studies comparing patients’ experience between those undergoing laparoscopic and open gynaecological surgery. Therefore, the aim of this prospective study is to compare patients’ functional recovery based on milestones set by the enhanced recovery programme and patients’ satisfaction between the two groups.MethodsAll eligible patients undergoing gynaecological surgery within an enhanced recovery after surgery (ERAS) programme from March to August 2014 were involved in this study. All patients received the questionnaires on admission which were then collected prior to discharge. They were followed up by telephone within 7 days.ResultsTwo hundred sixty-three patients were involved. One hundred forty-four questionnaires were returned (54% response rate). Fifty-one percent (n = 74) were from the laparoscopic group and 49% (n = 70) were from the laparotomy group. In terms of achieving milestones, more patients in the laparotomy group performed the deep breathing exercises (laparoscopic versus open; 66.2% versus 87.1% (p = 0.003). The laparoscopic group were more able to eat on day 0, but by day 1, there was no difference between the groups. Both groups were similar in their ability to drink (p = 0.98), mobilise (p = 0.123) and sit out in a chair (p = 0.511). In the laparoscopic group, the patients’ experience was better for pain control (p < 0.0001) and nausea control (p = 0.003) from recovery to day 1, and they were more able to put on their own clothes (p = 0.001) and were more confident in mobilising (p < 0.0001) and in going home (p < 0.0001). The laparoscopic group had greater patient satisfaction with their pain always being well controlled (p < 0.0001) whilst more patients in the laparotomy group reported being satisfied to very satisfied with their overall care on the gynaecology ward (p = 0.04). Both groups were equally satisfied with their care from nursing staff (p = 0.709) and doctors (p = 0.431).ConclusionThe two groups were in general equally able to achieve the majority of the milestones despite differences in symptoms such as pain, nausea and confidence in mobilising and going home. Pre-operative education can empower patients to engage in their recovery. There is a high level of patient satisfaction in both groups.

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

“…Over the last 25 years, minimal access surgery (MAS) has become an essential component of modern gynecology surgery, with many laparoscopic techniques now considered routine [1]. Gynecologic MAS is associated with a number of advantages over open surgery, including reduced blood loss, fewer perioperative complications, reduced post-operative pain, earlier recovery, shortened hospital stay, and improved cosmesis [1][2][3]. However, MAS for complex surgery is technically demanding and associated with a steep learning curve [1,[4][5][6][7].…”

“…However, MAS for complex surgery is technically demanding and associated with a steep learning curve [1,[4][5][6][7]. This is due to certain limitations of conventional laparoscopy such as restricted movement, difficulty performing accurate suturing, uncomfortable positions for the surgeon and assistant, and twodimensional vision [1][2][3]8]. These limitations may contribute to the relatively low adoption of MAS for commonly performed gynecologic procedures, such as hysterectomy and sacrocolpopexy [4,[9][10][11].…”

Effect of Enhanced Recovery Pathway on Hysterectomy Complications in Suez Canal University Hospital and General Hospital at Ismailia City

“…The mean of study group that performed coughing exercises and Kegel exercises were 81.74±17.57 and 81.06±17.7 respectively. Table (8) shows distribution of the study and control group according to wound care and compliance to treatment. 96.96% of the study group follow guidelines of wound care compared to women in control group with statistically significant p=0.000.…”

“…One innovative program is enhanced recovery after surgery, which aims to improve clinical outcomes and quality of care post-surgery and improve patients' experience after surgery [8]. ERAS aim to replace 'traditional surgical paradigms' with evidence-based strategies to improve women recovery [9].…”

The burden of performing minimal access surgery: ergonomics survey results from 462 surgeons across Germany, the UK and the USA

“…Consequently, MAS is established as a routine approach for an increasing range of surgeries including gynaecological, colorectal and urological procedures [5,6]. Compared with open surgery, MAS is associated with less intraoperative blood loss, fewer wound complications, and reduced blood transfusion rates and length of hospital stay [6][7][8]. These advantages are largely owing to the small size of the incision required at the surgical site.…”