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重新思考机器人辅助腹腔镜前列腺切除术后过夜住院的必要性。

Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy.

作者信息

Kotamarti Srinath, Williams Thomas, Silver Michael, Silver David A, Schulman Ariel A

机构信息

Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.

Hofstra-Northwell School of Medicine, 450 Lakeville Rd, Suite M42, Lake Success, NY, 11042, USA.

出版信息

J Robot Surg. 2020 Dec;14(6):913-915. doi: 10.1007/s11701-020-01115-1. Epub 2020 Jun 29.

Abstract

Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24 h of surgery. Recently, several high-volume surgeons demonstrated the safety of same-day discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperative care and the risk of missing a catastrophic event. In recent years, important advances have further strengthened the argument for SDD including more structured perioperative care, integration of single-port robotic systems, and new challenges presented by the coronavirus 2019 (COVID-19) pandemic. Here, we provide further evidence demonstrating the safety of SDD in a multi-institutional cohort of patients and review the main arguments supporting the expanded use of this approach.

摘要

机器人辅助腹腔镜前列腺切除术(RALP)是局限性前列腺癌(PCa)手术治疗的金标准。多机构系列研究表明,不到5%的患者会出现并发症和再次入院情况,而且现在大多数患者在手术后24小时内即可出院。最近,几位经验丰富的外科医生证明了RALP术后当日出院(SDD)的安全性。其主要益处包括降低成本以及减少医院感染和医疗差错的风险。批评的主要理由包括术后护理可能不够理想以及错过严重事件的风险。近年来,重要进展进一步强化了当日出院的理由,包括更结构化的围手术期护理、单孔机器人系统的整合以及2019冠状病毒病(COVID-19)大流行带来的新挑战。在此,我们提供进一步证据,证明在多机构患者队列中当日出院的安全性,并回顾支持扩大使用这种方法的主要理由。

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