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

Justin W. Collins, Hiten Patel, Christofer Adding, Magnus Annerstedt, Prokar Dasgupta, Shamim M. Khan, Walter Artibani, Richard Gaston, Thierry Piechaud, James W. Catto, Anthony Koupparis, Edward Rowe, Matthew Perry, Rami Issa, John McGrath, John Kelly, Martin Schumacher, Carl Wijburg, Abdullah E. Canda, Meviana D. BalbayKarel Decaestecker, Christian Schwentner, Arnulf Stenzl, Sebastian Edeling, Sasa Pokupić, Michael Stockle, Stefan Siemer, Rafael Sanchez-Salas, Xavier Cathelineau, Robin Weston, Mark Johnson, Fredrik D’Hondt, Alexander Mottrie, Abolfazl Hosseini, Peter N. Wiklund

Research output: Contribution to journalArticle (Academic Journal)peer-review

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.

Original languageEnglish
JournalEuropean Urology
Early online date24 May 2016
DOIs
Publication statusPublished - Oct 2016

Keywords

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

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