Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota..
J Minim Invasive Gynecol. 2019 Feb;26(2):288-298. doi: 10.1016/j.jmig.2018.10.016. Epub 2018 Oct 24.
Enhanced recovery after surgery (ERAS) is an evidence-based approach to perioperative care of the surgical patient. A mounting body of literature in gynecologic surgery has demonstrated that ERAS improves postoperative outcomes, shortens hospital length of stay, and reduces cost without increasing complications or readmissions. Most of the existing literature has concentrated on open surgery, questioning if patients undergoing minimally invasive surgery also derive benefit. Our aim was to systematically review the literature on ERAS after minimally invasive gynecologic surgery (MIGS) with and without bowel surgery. Given the paucity of studies on ERAS in MIGS with bowel surgery (1 study), we expanded our search to include studies of ERAS in patients undergoing minimally invasive colorectal resections alone. Twelve studies were identified through an electronic database search of PubMed, Medline, and Ovid EMBASE. These studies included patients undergoing MIGS for benign and/or malignant indications and showed that ERAS pathways decreased length of stay and/or increased the proportion of same-day discharge surgeries, improved patient satisfaction, and reduced hospital costs while maintaining low postoperative complication and readmission rates. Although limited, data from a single study suggest that ERAS in MIGS with bowel surgery leads to shortened hospital stay, stable postoperative morbidity, and less readmissions. Although the variation between the published protocols underscores the need for standardization, existing literature supports the adoption of ERAS as safe and effective when planning MIGS.
术后恢复加速（ERAS）是一种针对外科患者围手术期护理的循证方法。越来越多的妇科手术文献表明，ERAS 可改善术后结果，缩短住院时间，降低成本，而不会增加并发症或再入院率。大多数现有文献都集中在开放手术上，质疑接受微创手术的患者是否也能从中受益。我们的目的是系统地回顾关于微创妇科手术（MIGS）伴或不伴肠道手术的 ERAS 文献。鉴于关于 MIGS 伴肠道手术的 ERAS 研究较少（1 项研究），我们扩大了搜索范围，包括单独接受微创结直肠切除术的患者的 ERAS 研究。通过对 PubMed、Medline 和 Ovid EMBASE 电子数据库的搜索，确定了 12 项研究。这些研究包括因良性和/或恶性指征而行 MIGS 的患者，结果表明 ERAS 路径缩短了住院时间和/或增加了当日出院手术的比例，提高了患者满意度，并降低了住院费用，同时保持了较低的术后并发症和再入院率。尽管数据有限，但来自一项研究的数据表明，MIGS 伴肠道手术的 ERAS 可缩短住院时间，稳定术后发病率，并减少再入院。尽管发表的方案之间存在差异突出了标准化的必要性，但现有文献支持在计划 MIGS 时采用 ERAS，认为其安全且有效。
