Abboudi Hamid, Doyle Patrick, Winkler Mathias
Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London.
Arch Ital Urol Androl. 2017 Oct 3;89(3):182-185. doi: 10.4081/aiua.2017.3.182.
To evaluate the feasibility of performing laparoscopic radical prostatectomy (LRP) as a day case procedure while maintaining patient satisfaction and safety. Herein we report our experience, selection criteria, and discharge criteria for day case LRP.
We performed a prospective study with 32 patients undergoing extraperitoneal LRP. These patients were counselled before the procedure that they would go home the same evening of the procedure. Pain scores and quality of life data were recorded day 1 postoperatively via a telephone consultation. The patients underwent routine blood tests on day 2 and an outpatient review on day 7 and regularly thereafter via an assigned key worker. Socio-demographic data, comorbidities, and outcomes were collected for analysis.
All patients were successfully discharged the same day of surgery. Mean patient age was 62 years with a mean body mass index of 25. Mean operative time was 147 minutes, and estimated blood loss was 101 ml. Three patients were treated for post operative urinary tract infections; two patients developed infected lymphoceles which required percutaneous drainage and one patient required re-catheterisation due to a burst catheter balloon. Of these six complications four patients required re-admission. Post-operative pain, nausea and vomiting were low whilst patient satisfaction scores were unanimously high in all patients surveyed.
The early experience with extraperitoneal LRP as a same day surgery is promising although patients who are at high risk of lymphocele should be excluded. Preoperative patient counselling and selection is paramount. Patient satisfaction is not adversely affected by the shortened stay. Surgeon experience, a well-motivated patient, meticulous attention to detail through an integrated pathway, a multidisciplinary team and adequate postoperative assessment are essential.
评估将腹腔镜根治性前列腺切除术（LRP）作为日间手术进行的可行性，同时保持患者满意度和安全性。在此，我们报告我们开展日间手术LRP的经验、选择标准和出院标准。
我们对32例行腹膜外LRP的患者进行了一项前瞻性研究。在手术前向这些患者告知他们将在手术当天晚上回家。术后第1天通过电话咨询记录疼痛评分和生活质量数据。患者在术后第2天进行常规血液检查，并在术后第7天进行门诊复查，此后定期由指定的关键工作人员进行复查。收集社会人口统计学数据、合并症和结果进行分析。
所有患者均在手术当天成功出院。患者平均年龄为62岁，平均体重指数为25。平均手术时间为147分钟，估计失血量为101毫升。3例患者接受了术后尿路感染治疗；2例患者出现感染性淋巴囊肿，需要经皮引流，1例患者因导尿管球囊破裂需要重新插管。在这6例并发症中，4例患者需要再次入院。术后疼痛、恶心和呕吐程度较低，而所有接受调查的患者的满意度评分均一致较高。
腹膜外LRP作为同日手术的早期经验很有前景，尽管应排除淋巴囊肿高危患者。术前对患者进行咨询和选择至关重要。缩短住院时间不会对患者满意度产生不利影响。外科医生的经验、积极配合的患者、通过综合路径对细节的精心关注、多学科团队以及充分术后评估至关重要。
