Robot‐assisted radical cystectomy with intracorporeal urinary diversion: impact on an established enhanced recovery protocol

Abstract

ObjectivesTo assess the impact of the introduction of robot-assisted radical cystectomy (RARC) on an established enhanced recovery programme (ERP) and to examine the effect on mortality and morbidity rates, transfusion rates, and length of stay (LOS). Patients and MethodsData on 102 consecutive patients undergoing RARC with full intracorporeal reconstruction were obtained from our prospectively updated institutional database. These data were compared to previously published retrospective results from three separate groups of patients undergoing open radical cystectomy (ORC) at our centre. Our primary focus was perioperative outcomes including transfusion rate, complication rates, 30-and 90-day mortality rates, and LOS.

Intracorporeal robot‐assisted radical cystectomy, together with an enhanced recovery programme, improves postoperative outcomes by aggregating marginal gains

“…The present results are consistent with other reported outcomes after implementation of an ERAS pathway for RARC . A median LOS of 7–8 days is reported and avoidance of PCA has been highlighted as a major factor influencing LOS.…”

“…A median LOS of 7–8 days is reported and avoidance of PCA has been highlighted as a major factor influencing LOS. Although our preference is for spinal analgesia, the use of oxycodone is described by others . The European Association of Urology Robotic Section Scientific Working Group recently published consensus for enhanced recovery for RARC in efforts to guide the standardization of postoperative care .…”

“…The ERAS pathway was initially piloted and evolved for colorectal surgery and has led to reduction in LOS and complications without compromising patient safety . More recently, ERAS has been implemented for radical cystectomy, with reports of reductions in peri‐operative complication rates and in LOS to as low as 4 days . ERAS represent a multi‐modal peri‐operative care pathway designed to expedite postoperative recovery and improve morbidity by minimizing organ dysfunction and reducing the metabolic stress response secondary to surgery.…”

Enhanced Recovery Pathways Versus Standard Care After Cystectomy: A Meta-analysis of the Effect on Perioperative Outcomes

“…Although several studies have been published, striking variation exists in the effect of ERAS protocols on perioperative outcomes [4–15]. For example, some studies show that ERAS pathways can reduce the length of stay [4,6,10,11,14,16], whereas others do not [7,9,12,16]; some studies show that ERAS pathways can shorten the time to recovery of bowel activity [7,9,12], yet others do not [6,11]; some studies show that ERAS pathways can lower the rates of readmission [6,12,13]; but yet again, others do not [9,11,14]. …”

Kosten van open versus robotgeassisteerde radicale cystectomie tot 90 dagen postoperatief: een retrospectieve studie uit twee centra met in totaal 169 patiënten

“…Aangezien de invoering van dit protocol bij beide series in de periode viel dat de RARC als standaardoperatiemethode gebruikt werd, is het lastig de impact van de RARC en het protocol op de opnameduur van elkaar te onderscheiden. Wel zijn er aanwijzingen dat invoering van de RARC, ook als het Fasttrack protocol reeds ingevoerd is, tot verkorting van de opnameduur kan leiden [16]. Bij een toekomstig prospectief onderzoek zal het postoperatieve traject voor zowel ORC als RARC in dit opzicht gelijk moeten zijn.…”