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ERAS Protocol in RARP

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Robotic Surgery

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Abstract

Enhanced recovery after surgery (ERAS) comprises a multidisciplinary approach to the management of surgical patients. It involves the delivery of protocolised care from the pre-operative planning phase, through the hospital admission for surgery, to the post-operative recovery outside of hospital. By following an enhanced recovery protocol it is possible for the multidisciplinary team to deliver consistent high-quality care, with deviation from protocol only occurring in particular justified circumstances. This standardised approach improves communication, efficiency and the acquisition of skills by team members.

ERAS is very effective in combination with minimally invasive surgery and especially so in robot-assisted radical prostatectomy (RARP). Pre-operative factors that are addressed include optimisation of comorbidities, introduction to pelvic floor exercises and learning catheter self-care. Perioperatively, analgesic requirements are reduced due to small incisions and minimal bowel handling. Intravenous fluid administration is minimised and early enteral nutrition and mobilisation are promoted. Catheter duration is minimised post-operatively and drains only utilised if clearly indicated. Patients are discharged early following the fulfilment of set criteria, with readily accessible support available.

ERAS for RARP has allowed length of stay to be significantly reduced and it potentially reduces complication rates. ERAS constitutes effective and economical healthcare delivery and is commonly favoured by healthcare commissioners and patients alike. The ERAS approach to RARP provides patients with greater empowerment and aims to reduce the functional and psychological impact that radical prostatectomy has on patients.

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References

  1. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011; https://doi.org/10.1002/14651858.CD007635.pub2.

  2. Arumainayagam N, McGrath J, Jefferson KP, Gillatt DA. Introduction of an enhanced recovery protocol for radical cystectomy. BJU Int. 2008;101:698–701.

    Article  PubMed  Google Scholar 

  3. Goossens-Laan CA, et al. Survival after treatment for carcinoma invading bladder muscle: a Dutch population based study on the impact of hospital volume. BJU Int. 2012;110:226–32.

    Article  PubMed  Google Scholar 

  4. Simpson JC, et al. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. Br J Anaesth. 2015;115:560–8.

    Article  CAS  PubMed  Google Scholar 

  5. Grant MC, Yang D, Wu CL, Makary MA, Wick EC. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg. 2017;265:68–79.

    Article  PubMed  Google Scholar 

  6. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.

    Article  CAS  PubMed  Google Scholar 

  7. NHS. Fulfilling the potential. A better journey for patients and a better deal for the NHS\r. NHS Best Pract Guid. 2012;68.

    Google Scholar 

  8. NHS. Delivering enhanced recovery. 2010:1–42.

    Google Scholar 

  9. ACS. American College of Surgeons urges hospitals to enroll now in a national program to help implement enhanced recovery pathways for colorectal, orthopedic, and gynecologic surgery. ACS website. 2018. Available at: https://www.facs.org/media/press-releases/2018/iscr121918. Accessed: 16 May 2019.

  10. Campain N, Mcgrath J, Jackson L, Batchelor N, Daugherty M, Waine E. ‘Same day discharge’ RALP-the ultimate form of enhanced recovery. Eur Urol Suppl. 2014;13:15–6.

    Article  Google Scholar 

  11. BAUS. BAUS surgical outcomes audit. BAUS website. 2019. Available at: https://www.baus.org.uk/patients/surgical_outcomes/radical_prostatectomy/hospital.aspx?id=143. Accessed: 16 May 2019.

  12. Abou-Haidar H, et al. Enhanced recovery pathway for radical prostatectomy: implementation and evaluation in a universal healthcare system. J Can Urol Assoc. 2014;8:418–23.

    Article  Google Scholar 

  13. NICE. Blood transfusion quality standard. NICE website. 2016. Available at: https://www.nice.org.uk/guidance/qs138/chapter/Quality-statement-1-Iron-supplementation. Accessed: 11 May 2019.

  14. Froessler B, et al. The important role for intravenous iron in perioperative patient blood management in major abdominal surgery. Ann Surg. 2016;264:41–6.

    Article  PubMed  Google Scholar 

  15. Goonewardene SS, Gillatt D, Persad R. A systematic review of PFE pre-prostatectomy. J Robot Surg. 2018;12:397–400.

    Article  CAS  PubMed  Google Scholar 

  16. Mottet N, van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, Gillessen S, Govorov A, Grummet J, Henry AM, Lam TB, Mason MD, van der Poel HG, van der Kwast TH, Rouvière O, Wiegel T; Guidelines Associates, Van den Broeck T, Cumberbatch M, Fossati N, Gross T, Lardas M, Liew M, Moris L, Schoots IG, Willemse PM. EAU prostate cancer guideline. Prostate cancer guideline. 2018.

    Google Scholar 

  17. Santa Mina D, et al. Prehabilitation for radical prostatectomy: a multicentre randomized controlled trial. Surg Oncol. 2018;27:289–98.

    Article  PubMed  Google Scholar 

  18. Singh F, et al. Feasibility of presurgical exercise in men with prostate cancer undergoing prostatectomy. Integr Cancer Ther. 2017;16:290–9.

    Article  PubMed  Google Scholar 

  19. Cerantola Y, et al. Are patients at nutritional risk more prone to complications after major urological surgery? J Urol. 2013;190:2126–32.

    Article  PubMed  Google Scholar 

  20. Karl A, et al. Prospective assessment of malnutrition in urologic patients. Urology. 2009;73:1072–6.

    Article  PubMed  Google Scholar 

  21. Sooriakumaran P, et al. Erectile function and oncologic outcomes following open retropubic and robot-assisted radical prostatectomy: results from the laparoscopic prostatectomy robot open trial. Eur Urol. 2018;73:618–27.

    Article  PubMed  Google Scholar 

  22. Prostate Cancer UK. Pelvic floor muscle exercises. Prostate Cancer UK website. Available at: https://prostatecanceruk.org/media/975926/pelvic_floor_exercises-ifm.pdf. Accessed: 30 Apr 2019.

  23. Reynolds BR, et al. Exploring pathways towards improving patient experience of robot-assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes. BJU Int. 2018;121:33–9.

    Article  PubMed  Google Scholar 

  24. Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013;32:34–44.

    Article  CAS  PubMed  Google Scholar 

  25. Mccall J, Plank L, Gp H, Soop M, Nygren J. Preoperative carbohydrate treatment for enhancing recovery after elective surgery (Review). Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD009161.pub2.www.cochranelibrary.com.

  26. Ljungqvist O, Jonathan E. Rhoads lecture 2011: insulin resistance and enhanced recovery after surgery. JPEN J Parenter Enteral Nutr. 2012;36:389–98.

    Article  CAS  PubMed  Google Scholar 

  27. Brady M, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003; https://doi.org/10.1007/bf03077179.

  28. Yuill KA, Richardson RA, Davidson HIM, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively—a randomised clinical trial. Clin Nutr. 2005;24:32–7.

    Article  CAS  PubMed  Google Scholar 

  29. Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014;96:15–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Midlands W. Dexamethasone versus standard treatment for postoperative nausea and vomiting in gastrointestinal surgery: randomised controlled trial (DREAMS trial). BMJ. 2017;357:j1455.

    Google Scholar 

  31. Lee JR. Anesthetic considerations for robotic surgery. Korean J Anesthesiol. 2014;66:3–11.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ferroni MC, Abaza R. Feasibility of robot-assisted prostatectomy performed at ultra-low pneumoperitoneum pressure of 6 mmHg and comparison of clinical outcomes vs standard pressure of 15 mmHg. BJU Int. 2019;124(2):308–13.

    Article  CAS  PubMed  Google Scholar 

  33. Abaza R, Martinez O, Ferroni MC, Bsatee A, Gerhard RS. Same day discharge after robotic radical prostatectomy. J Urol. 2019; https://doi.org/10.1097/JU.0000000000000353.

  34. Dunnebier A, et al. Laryngeal tube suction II or endotracheal intubation for laparoscopic radical prostatectomy in a head down position: a randomised controlled trial. Eur J Anaesthesiol. 2017;34:441–7.

    Article  PubMed  Google Scholar 

  35. Ilic D, et al. Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer. Cochrane Database Syst Rev. 2017;9:CD009625.

    Google Scholar 

  36. By P, Baus THE, Group ERP. BAUS enhanced recovery pathway. Br Assoc Urol Surg. 2015;44

    Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK

    Joseph Byron John & John Samuel McGrath

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  1. Joseph Byron John
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  2. John Samuel McGrath
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Editors and Affiliations

  1. Center for Advanced Thoracic Surgery, Global Robotics Institute Advent Health Celebration, Celebration, FL, USA

    Farid Gharagozloo

  2. Global Robotics Institute, Advent Health Celebration, Celebration, FL, USA

    Vipul R. Patel

  3. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

    Pier Cristoforo Giulianotti

  4. Department of Cardiothoracic Surgery, Three Crosses Regional Hospital, Las Cruces, NM, USA

    Robert Poston

  5. Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Rainer Gruessner

  6. Department of Surgery, Wellington Regional Medical Center, Wellington, FL, USA

    Mark Meyer

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John, J.B., McGrath, J.S. (2021). ERAS Protocol in RARP. In: Gharagozloo, F., Patel, V.R., Giulianotti, P.C., Poston, R., Gruessner, R., Meyer, M. (eds) Robotic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-53594-0_110

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  • DOI: https://doi.org/10.1007/978-3-030-53594-0_110

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-53594-0

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