Day case laparoscopic radical prostatectomy

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.