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Eur Urol. 2016 Oct;70(4):649-660. doi: 10.1016/j.eururo.2016.05.020. Epub 2016 May 24.

Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.

Author information

1
Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
2
Department of Urology, University Hospital of Northern Norway, Tromsø, Norway.
3
Department of Urology, Stockholm Urology Clinic, Stockholm, Sweden.
4
Department of Urology, Guys Hospital, London, UK.
5
Department of Urology, Verona University Hospital, Verona, Italy.
6
Clinique Saint Augustin, Bordeaux, France.
7
Department of Urology, Sheffield University Hospital, Sheffield, UK.
8
Department of Urology, Bristol Urological Institute, Bristol, UK.
9
Department of Urology, St Georges, London, UK.
10
Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK.
11
Department of Urology, UCL, London, UK.
12
Department of Urology, Hirslanden Klinik, Aarau, Switzerland.
13
Department of Urology, Rijnstate, Arnhem, Netherlands.
14
Department of Urology, Ankara Ataturk Hospital, Ankara, Turkey.
15
Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey.
16
Department of Urology, Ghent University, Ghent, Belgium.
17
Department of Urology, University of Tuebingen, Tubingen, Germany.
18
Department of Urology, Da Vinci Zentrum, Hanover, Germany.
19
Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany.
20
Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
21
Department of Urology, Royal Liverpool Hospital, Liverpool, UK.
22
Department of Urology, Newcastle upon Tyne Hospitals, Newcastle, UK.
23
Department of Urology, O.L.V, Aalst, Belgium.
24
Department of Urology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: peter.wiklund@karolinska.se.

Abstract

CONTEXT:

Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials.

OBJECTIVE:

To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients.

EVIDENCE ACQUISITION:

The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee.

EVIDENCE SYNTHESIS:

Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation.

CONCLUSIONS:

This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs.

PATIENT SUMMARY:

There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We reported a consensus view on a standardised ERP specific to patients undergoing RARC. It was formulated by experts from high-volume RARC hospitals in Europe, combining current evidence for ERPs with experts' knowledge of perioperative care for robotic surgery.

KEYWORDS:

ERAS; Enhanced recovery after surgery; Enhanced recovery protocol; RARC; Radical cystectomy; Robot-assisted radical cystectomy

PMID:
27234997
DOI:
10.1016/j.eururo.2016.05.020
[Indexed for MEDLINE]

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