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Fast-track surgery in laparoscopic radical prostatectomy: basic principles

World Journal of Urology volume 25, pages 185–191 (2007)Cite this article

Abstract

Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase. The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer. Twenty-five patients each were randomized in the study groups to verify if a fast-track regimen could be transferred into clinical routine. The perioperative data, early complications, hospital stay as well as readmission rate were analyzed. The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group. The overall complications were significantly less in the fast-track procedure. The readmission rate was low and not significant. Patients receiving an LRPE benefit from a suitable fast-track concept. The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate. Thus, fast-track concepts might contribute to saving resources in the long term. However, more evidence based on larger prospective trials is needed to achieve optimal quality of life for patients perioperatively.

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References

  1. Agnelli G (2004) Prevention of venous thromboembolism in surgical patients. Circulation 14:4–12

    Google Scholar 

  2. Bauer AJ, Boeckxstaens GE (2004) Mechanisms of postoperative ileus. Neurogastroenterol Motil 16:54–60

    PubMed  Article  Google Scholar 

  3. Bianco FJ Jr, Riedel ER, Begg CB, Kattan MW, Scardino PT (2005) Variations among high volume surgeons in the rate of complications after radical prostatectomy: further evidence that technique matters. J Urol 173:2099–2103

    PubMed  Article  Google Scholar 

  4. Biancofiore G, Bindi ML, Romanelli AM, Boldrini A, Bisa M, Esposito M, Urbani L, Catalano G, Mosca F, Filipponi F (2005) Fast track in liver transplantation: 5 years’ experience. Eur J Anaesthesiol 22:584–590

    PubMed  Article  CAS  Google Scholar 

  5. Bollens R, Roumeguere T, Vanden Bossche M, Quackels T, Zlotta AR, Schulman CC (2002) Comparison of laparoscopic radical prostatectomy techniques. Curr Urol Rep 3:148–151

    PubMed  Google Scholar 

  6. Cartwright MM (2004) The metabolic response to stress: a case of complex nutrition support management. Crit Care Nurs Clin North Am 16:467–487

    PubMed  Google Scholar 

  7. Correia MI, da Silva RG (2004) The impact of early nutrition on metabolic response and postoperative ileus. Curr Opin Clin Nutr Metab Care 7:577–583

    PubMed  Article  Google Scholar 

  8. Erikoglu M, Yol S, Avunduk MC, Erdemli E, Can A (2005) Electron-microscopic alterations of the peritoneum after both cold and heated carbon dioxide pneumoperitoneum. J Surg Res 125:73–77

    PubMed  Article  Google Scholar 

  9. Grewal H, Sweat J, Vazquez WD (2004) Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 8:151–154

    PubMed  Google Scholar 

  10. Heinzer H, Heuer R, Nordenflycht O, Eichelberg C, Friedrich P, Goetz AE, Huland H (2005) Fast-track surgery in radical retropubic prostatectomy. First experiences with a comprehensive program to enhance postoperative convalescence. Urologe A, epub Sept. 23

  11. Hemmerling TM, Le N, Olivier JF, Choiniere JL, Basile F, Prieto I (2005) Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia. J Cardiothorac Vasc Anesth 19:176–181

    PubMed  Article  Google Scholar 

  12. Jacobs VR, Morrison JE Jr, Mettler L, Mundhenke C, Jonat W (1999) Measurement of CO2 hypothermia during laparoscopy and pelviscopy: how cold it gets and how to prevent it. J Am Assoc Gynecol Laparosc 6:289–295

    PubMed  Article  CAS  Google Scholar 

  13. Jacobs VR, Morrison JE Jr, Kiechle M (2004) Twenty-five simple ways to increase insufflation performance and patient safety in laparoscopy. J Am Assoc Gynecol Laparosc 11:410–423

    PubMed  Article  Google Scholar 

  14. Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG (2003) Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A Biol Sci Med Sci 58:1042–1045

    PubMed  Google Scholar 

  15. Kehlet H, Mogensen T (1999) Hospital stay of 2 days after open sigmoidectomy with a multimodal rehabilitation programme. Br J Surg 86:227–230

    PubMed  Article  CAS  Google Scholar 

  16. Kehlet H, Wilmore DW (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78:606–617

    PubMed  CAS  Google Scholar 

  17. Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183:630–641

    PubMed  Article  Google Scholar 

  18. Kotzampassi K, Paramythiotis D, Eleftheriadis E (2000) Deterioration of visceral perfusion caused by intra-abdominal hypertension in pigs ventilated with positive end-expiratory pressure. Surg Today 30:987–992

    PubMed  Article  CAS  Google Scholar 

  19. Mukherjee D (2003) “Fast-track” abdominal aortic aneurysm repair. Vasc Endovascular Surg 37:329–334

    PubMed  Article  Google Scholar 

  20. Nygren J, Hausel J, Kehlet H, Revhaug A, Lassen K, Dejong C, Andersen J, von Meyenfeldt M, Ljungqvist O, Fearon KC (2005) A comparison in five European Centres of case mix, clinical management and outcomes following either conventional or fast-track perioperative care in colorectal surgery. Clin Nutr 24:455–461

    PubMed  Article  Google Scholar 

  21. Oetker-Black SL, Jones S, Estok P, Ryan M, Gale N, Parker C (2003) Preoperative teaching and hysterectomy outcomes. AORN J 77:1221–1231

    Google Scholar 

  22. Omar AM, Townell N (2004) Laparoscopic radical prostatectomy a review of the literature and comparison with open techniques. Prostate Cancer Prostatic Dis 7:295–301

    PubMed  CAS  Article  Google Scholar 

  23. Ottesen M, Sorensen M, Kehlet H, Ottesen B (2003) Short convalescence after vaginal prolapse surgery. Acta Obstet Gynecol Scand 82:359–366

    PubMed  Article  Google Scholar 

  24. Powel LL, Clark JA (2005) The value of the marginalia as an adjunct to structured questionnaires: experiences of men after prostate cancer surgery. Qual Life Res 14:827–835

    PubMed  Article  Google Scholar 

  25. Remzi M, Klingler HC, Tinzl MV, Fong YK, Lodde M, Kiss B, Marberger M (2005) Morbidity of laparoscopic extraperitoneal versus transperitoneal radical prostatectomy verus open retropubic radical prostatectomy. Eur Urol 48:83–89

    PubMed  Article  CAS  Google Scholar 

  26. Rosin D, Brasesco O, Varela J, Saber AA, You S, Rosenthal RJ, Cohn SM (2002) Low-pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion. J Laparoendosc Adv Surg Tech A 12:15–19

    PubMed  Article  Google Scholar 

  27. Schulam PG, Link RE (2000) Laparoscopic radical prostatectomy. World J Urol 18:278–282

    PubMed  Article  CAS  Google Scholar 

  28. Schwenk W, Muller JM (2005) What is “fast-track”-surgery? Dtsch Med Wochenschr 130:536–540

    PubMed  Article  CAS  Google Scholar 

  29. Schwenk W, Raue W, Haase O, Junghans T, Müller JM (2004) Fast-track-Kolonchirurgie. Chirurg 75:508–514

    PubMed  Article  CAS  Google Scholar 

  30. Shea RA, Brooks JA, Dayhoff NE, Keck J (2002) Pain intensity and postoperative pulmonary complications among the elderly after abdominal surgery. Heart Lung 31:440–444

    PubMed  Article  Google Scholar 

  31. Turk I, Deger S, Winkelmann B, Schonberger B, Loening SA (2001) Laparoscopic radical prostatectomy. Technical aspects and experience with 125 cases. Eur Urol 40:46–52

    PubMed  Article  CAS  Google Scholar 

  32. Wilmore DW (2002) From Cuthbertson to fast-track surgery: 70 years of progress in reducing stress in surgical patients. Ann Surg 236:643–648

    PubMed  Article  Google Scholar 

  33. Wilmore DW, Kehlet H (2001) Management of patients in fast track surgery. BMJ 322:473–476

    PubMed  Article  CAS  Google Scholar 

  34. Windsor JA, Hill GL (1988) Protein depletion and surgical risk. Aust N Z J Surg 58:711–715

    PubMed  CAS  Google Scholar 

  35. Wood JD, Galligan JJ (2004) Function of opioids in the enteric nervous system. Neurogastroenterol Motil 16:17–28

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Urology, Campus Mitte, Charité—Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117, Berlin, Germany

    O. Gralla, F. Haas, M. Tullmann, A. Romer, S. Deger, V. Ebeling, M. Lein, A. Wille, B. Rehberg, S. A. Loening & J. Roigas

  2. Institute for Medical Psychology, Campus Mitte, Charité—Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117, Berlin, Germany

    N. Knoll

  3. Department of Anaesthesiology, Campus Mitte, Charité—Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117, Berlin, Germany

    D. Hadzidiakos

Authors
  1. O. Gralla
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  2. F. Haas
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  3. N. Knoll
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  4. D. Hadzidiakos
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  5. M. Tullmann
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  6. A. Romer
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  7. S. Deger
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  8. V. Ebeling
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  9. M. Lein
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  10. A. Wille
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  11. B. Rehberg
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  12. S. A. Loening
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  13. J. Roigas
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Correspondence to O. Gralla.

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Gralla, O., Haas, F., Knoll, N. et al. Fast-track surgery in laparoscopic radical prostatectomy: basic principles. World J Urol 25, 185–191 (2007). https://doi.org/10.1007/s00345-006-0139-2

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  • DOI: https://doi.org/10.1007/s00345-006-0139-2

Keywords

  • Laparoscopic radical prostatectomy
  • LRPE
  • Fast-track surgery
  • Convalescence