[35] The impact of the ’optimised surgical journey’ on robot-assisted radical prostatectomy patients: A prospective non-randomised longitudinal cohort study

Objective: To examine the impact of a standardised postoperative algorithm on robot-assisted radical prostatectomies (RARPs) performed at our centre in Kuwait. Prostate cancer is the most common cancer in Kuwaiti males since 2011 and after acquiring the Da Vinci® Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) in 2013, a RARP programme was established. Methods: We collected data prospectively on all RARP cases performed since February 2014. We used the Clavien–Dindo system to grade complications, defining major complications as Clavien–Dindo Grade ⩾III. We examined recovery variables of all patients. We adopted a standardised postoperative algorithm called the ‘optimised surgical journey’ (OSJ) for managing RARP patients. Results: Between February 2014 and June 2018, a single surgeon’s robotic experience at Sabah Alahmad Urology Center (SAUC) included a total of 136 cases (116 cases done as the main console surgeon and 20 cases done with an invited robotic proctor). Of these, 53 cases (39%) were RARP (47 cases as the main console surgeon and six cases with an invited robotic proctor). The mean patient age was 62 years. The mean prostate volume was 50 mL. The mean estimated blood loss was 100 mL. Five patients had positive surgical margins (9%). The initial 12 RARPs were managed with non-standardised postoperative orders; the mean hospital stay was 4.83 days. Since April 2015, 41 patients underwent the OSJ protocol, reducing hospital stay by 2.57 days (P< 0.001). We report only one major complication (Clavien–Dindo Grade IIIb), where the patient had a prolonged leak requiring prolonged catheterisation and cystoscopy with cystogram under general anaesthesia, but no significant association with the OSJ. Conclusion: Standardised postoperative pathways improve recovery of patients undergoing major procedures like RARP. The OSJ decreased hospital stay without compromising surgical or oncological outcomes. Limitations are the small number of patients, lack of randomisation and possible impact of the learning curve on the initial cases