Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy

Abstract

Purpose The standard discharge pathway following robotic-assisted laparoscopic prostatectomy (RALP) involves overnight hospital admission. Models for same-day discharge (SDD) have been explored for multiport RALP, however, less is known regarding SDD for single-port RALP, especially in terms of patient experience. Methods Patient enrollment, based on preoperative determination of potential SDD eligibility, commenced March 2020 and ended March 2021. Day-of-surgery criteria were utilized to determine which enrolled patients underwent SDD. Differences in preoperative characteristics and perioperative outcomes between patients undergoing SDD and patients undergoing standard discharge were evaluated. A prospectively administered questionnaire was designed to characterize patient-centered factors informing SDD perception. Results Fifteen patients underwent SDD and 36 underwent standard discharge. Overall mean ± SD age and BMI were 63.6 ± 7.0 years and 29.7 ± 4.4 kg/m 2 , respectively. Mean operative time was shorter in the SDD cohort than the standard discharge cohort (188 min vs 217 min, p = 0.011). A higher proportion of cases that underwent SDD were performed using the Retzius-sparing approach, 80% (12/15) vs 33% (12/36) in the standard discharge cohort ( p = 0.005). Rates of 90 day complication ( p = 0.343), 90 day readmission ( p = 0.144), and 90 day emergency department visits ( p = 0.343) rates were all not significantly different between cohorts. Of questionnaire respondents undergoing standard discharge, 32% (8/25) cited pain as a reason for not undergoing SDD. Conclusions With comparable outcomes to the standard discharge pathway, SDD is safe and effective in single-port RALP. Post-operative pain and perceptions of distance are implicated as patient-centered barriers to SDD; proactive pain management and patient education strategies may facilitate SDD.

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses

“…Our LOS findings for SP versus MP in high complexity masses support these results. While fewer incisions may be a factor in shorter LOS for high complexity SP cases, (1) we did not observe a similar difference in low complexity cases, and (2) our study timeline overlapped the COVID-19 pandemic, which has been associated with significantly higher rates of same-day discharge after robot-assisted urologic surgery [ 17 , 18 ]. Other recent studies have noted decreased operative time and EBL for retroperitoneal MP-RAPN compared to the transperitoneal approach [ 19 , 20 ].…”

Commentary RE: Balasubramanian S, Ronstrom C, Shiang A, Vetter JM, Sheets J, Palka J, Figenshau RS, Kim EH. Feasibility and safety of same-day discharge following single-port robotic-assisted laparoscopic prostatectomy. World J Urol. 2022 Nov 2:1–7. doi: 10.1007/s00345-022-04204-y. Epub ahead of print. PMID: 36322183; PMCID: PMC9629187

“…Of the 51 patients eligible for SDD after SP-RALP, 15 underwent SDD, and 36 opted for standard discharge process due to various reasons such as pain, fatigue, other medical reasons, and nonmedical reasons related to distance from hospital and being a second start surgery. [ 3 ] Encouragingly, the study demonstrated comparable outcomes in regard to complications, 90-day readmission and 90-day emergency room visits between the SDD and standard discharge process.…”

The spread of retzius-sparing robotic prostatectomy: an update after 10 years

“…Of note, 24 studies comparing RS-RARP to other approaches have been published up to April 15, 2023. Most reports aimed to demonstrate differences between RS-RARP and other approaches in terms of early and late urinary continence (Table 1) [5–8,9 ▪ ,10,11 ▪ ,12–16,17 ▪ ,18,19 ▪ ,20–22,23 ▪ ,24 ▪▪ ,25–28], but none focused on erectile function as primary endpoint. A minority of the studies reported data on sexual function, never finding significant differences among the RARP approaches.…”