Same‐day discharge robot‐assisted laparoscopic prostatectomy: feasibility, safety and patient experience

• Published in: BJU international 2023-07, Vol.132 (1), p.92-99
• Main Authors: Hill, George Thomas, Jeyanthi, Mekha, Coomer, William, Bryant, Richard J., Colmsee, Matthew T., Tozer, James, Cox, Adam Christopher, Wilson, Jim R.
• Format: Article
• Language: English
• Subjects: Aged; day‐case surgery; enhanced recovery; ERAS; feasibility; Feasibility Studies; Humans; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Middle Aged; Morbidity; Neoplasm Recurrence, Local - surgery; Patient Discharge; Patient Outcome Assessment; patient satisfaction; Patients; PCSM; ProstateCancer; Prostatectomy; Prostatectomy - adverse effects; Prostatectomy - methods; Prostatic Neoplasms - pathology; Prostatic Neoplasms - surgery; RALP; RARP; Recovery (Medical); Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotics; Robots; robot‐assisted radical prostatectomy; Surgery; Treatment Outcome; Urological surgery
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.16002

Objectives To report a single centre's experience of the feasibility, safety and patient acceptability of same‐day discharge robot‐assisted laparoscopic prostatectomy (RALP). Subjects/Patients and Methods Between June 2015 and December 2021, a total of 180 pre‐selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same‐day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. Results Of 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63 ( 44–74) years. The median (range) console time was 97 (61–256) min and blood loss was 200 (20–800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2–3 and 8.4% had GGG 4–5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (0.2 ng/mL). The 30‐day readmission rate was 3%. A total of 13 early (0–30 days) complications were observed, five of which were Clavien–Dindo grade ≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. Conclusion Robot‐assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well‐liked by patients, with morbidity and oncological outcomes similar to non‐day‐case or 23 h stay RALP.