Sorbonne University, GRC 5 Predictive Onco-Urology, APHP, Urology, Hôpital Pitié Salpêtrière, Paris, France.
Sorbonne University, GRC 5 Predictive Onco-Urology, APHP, Urology, Hôpital Pitié Salpêtrière, Paris, France.
Urology. 2022 Jun;164:145-150. doi: 10.1016/j.urology.2022.03.021. Epub 2022 Apr 8.
To assess the feasibility and safety of same-day discharge (SDD) surgery after robot-assisted partial nephrectomy (RAPN) in patients with small renal tumors.
Observational, monocentric study conducted over a one-year period.
good performance status, Charlson score <5, cT1a renal mass and RENAL score <6.
coagulopathy or contraindication to outpatient surgery. RAPN was performed as the first case of the day. Anesthesia protocols allowed quick recovery and rapid hospital discharge. Patients were called systematically 1-day post-surgery to enquire about any early complications. Perioperative outcomes and complications were recorded according to Intraoperative adverse incident classification by the European Association of Urology and Clavien classifications 30- and 90-days post-surgery. Follow-up consultations were carried out with assessment of patient satisfaction. Primary outcomes were SDD failure, 30- and 90-day complications and readmission rate. Descriptive data were reported without statistical comparative analysis.
Twenty patients were included (median age: 63 years [interquartile range: 57-64]). All patients were discharged home after a median surveillance time of 350 min (interquartile range: 270-420). One grade 1 intraoperative complication was reported. Two procedures were followed by an unplanned readmission due to early complications within the first 30 days (1 pain and anxiety [Clavien I], one active bleeding requiring embolization [Clavien IIIa]). The majority (85%) of patients were satisfied and would recommend day surgery. SDD failure rate was 10% at 90 days.
RAPN is safe as a SDD procedure without major perioperative morbidity for selected tumors and patients.
评估机器人辅助部分肾切除术（RAPN）后小肾肿瘤患者当日出院（SDD）手术的可行性和安全性。
在为期一年的时间内进行了一项观察性、单中心研究。
一般状况良好，Charlson 评分<5，cT1a 肾肿瘤和 RENAL 评分<6。
凝血功能障碍或门诊手术禁忌证。RAPN 作为当天的第一例手术进行。麻醉方案允许快速恢复和快速出院。术后 1 天系统地对患者进行电话随访，以询问是否有早期并发症。根据欧洲泌尿外科学会和 Clavien 分类的术中不良事件分类和术后 30 天和 90 天的分类记录围手术期结果和并发症。通过评估患者满意度进行随访咨询。主要结局为 SDD 失败、30 天和 90 天并发症和再入院率。未进行统计学比较分析，仅报告描述性数据。
共纳入 20 例患者（中位年龄：63 岁[四分位距：57-64]）。所有患者在中位监测时间 350 分钟（四分位距：270-420）后出院回家。报告了 1 例 1 级术中并发症。由于术后 30 天内发生早期并发症，有 2 例患者需要非计划再入院（1 例疼痛和焦虑[Clavien I]，1 例需要栓塞的活动性出血[Clavien IIIa]）。大多数（85%）患者满意并会推荐日间手术。90 天时 SDD 失败率为 10%。
对于选定的肿瘤和患者，RAPN 作为 SDD 手术是安全的，围手术期无严重并发症。
