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. Balbay; Karel 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

doi:10.1016/j.eururo.2016.05.020

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

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

130 Citations (Scopus)

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 language	English
Journal	European Urology
Early online date	24 May 2016
DOIs	https://doi.org/10.1016/j.eururo.2016.05.020
Publication status	Published - Oct 2016

Keywords

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

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Collins, J. W., Patel, H., Adding, C., Annerstedt, M., Dasgupta, P., Khan, S. M., Artibani, W., Gaston, R., Piechaud, T., Catto, J. W., Koupparis, A., Rowe, E., Perry, M., Issa, R., McGrath, J., Kelly, J., Schumacher, M., Wijburg, C., Canda, A. E., ... Wiklund, P. N. (2016). Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View. European Urology. https://doi.org/10.1016/j.eururo.2016.05.020

@article{e0ccf97c915a4e36b895594c798a6b4a,

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

abstract = "ContextRadical 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.ObjectiveTo provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients.Evidence acquisitionThe 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 synthesisConsensus 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.ConclusionsThis 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 summaryThere 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{\textquoteright} knowledge of perioperative care for robotic surgery.",

keywords = "Enhanced recovery protocol, Robot-assisted radical cystectomy, RARC, Radical cystectomy, Enhanced recovery after surgery, ERAS",

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

year = "2016",

month = oct,

doi = "10.1016/j.eururo.2016.05.020",

language = "English",

journal = "European Urology",

issn = "0302-2838",

publisher = "Elsevier B.V.",

}

Collins, JW, Patel, H, Adding, C, Annerstedt, M, Dasgupta, P, Khan, SM, Artibani, W, Gaston, R, Piechaud, T, Catto, JW, Koupparis, A, Rowe, E, Perry, M, Issa, R, McGrath, J, Kelly, J, Schumacher, M, Wijburg, C, Canda, AE, Balbay, MD, Decaestecker, K, Schwentner, C, Stenzl, A, Edeling, S, Pokupić, S, Stockle, M, Siemer, S, Sanchez-Salas, R, Cathelineau, X, Weston, R, Johnson, M, D’Hondt, F, Mottrie, A, Hosseini, A & Wiklund, PN 2016, 'Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View', European Urology. https://doi.org/10.1016/j.eururo.2016.05.020

TY - JOUR

T1 - Enhanced Recovery After Robot-assisted Radical Cystectomy

T2 - EAU Robotic Urology Section Scientific Working Group Consensus View

AU - Collins, Justin W.

AU - Patel, Hiten

AU - Adding, Christofer

AU - Annerstedt, Magnus

AU - Dasgupta, Prokar

AU - Khan, Shamim M.

AU - Artibani, Walter

AU - Gaston, Richard

AU - Piechaud, Thierry

AU - Catto, James W.

AU - Koupparis, Anthony

AU - Rowe, Edward

AU - Perry, Matthew

AU - Issa, Rami

AU - McGrath, John

AU - Kelly, John

AU - Schumacher, Martin

AU - Wijburg, Carl

AU - Canda, Abdullah E.

AU - Balbay, Meviana D.

AU - Decaestecker, Karel

AU - Schwentner, Christian

AU - Stenzl, Arnulf

AU - Edeling, Sebastian

AU - Pokupić, Sasa

AU - Stockle, Michael

AU - Siemer, Stefan

AU - Sanchez-Salas, Rafael

AU - Cathelineau, Xavier

AU - Weston, Robin

AU - Johnson, Mark

AU - D’Hondt, Fredrik

AU - Mottrie, Alexander

AU - Hosseini, Abolfazl

AU - Wiklund, Peter N.

PY - 2016/10

Y1 - 2016/10

N2 - ContextRadical 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.ObjectiveTo provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients.Evidence acquisitionThe 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 synthesisConsensus 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.ConclusionsThis 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 summaryThere 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.

AB - ContextRadical 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.ObjectiveTo provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients.Evidence acquisitionThe 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 synthesisConsensus 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.ConclusionsThis 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 summaryThere 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.

KW - Enhanced recovery protocol

KW - Robot-assisted radical cystectomy

KW - RARC

KW - Radical cystectomy

KW - Enhanced recovery after surgery

KW - ERAS

U2 - 10.1016/j.eururo.2016.05.020

DO - 10.1016/j.eururo.2016.05.020

M3 - Article (Academic Journal)

C2 - 27234997

SN - 0302-2838

JO - European Urology

JF - European Urology

ER -

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

Abstract

Keywords

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