Positive influence of robotically assisted laparoscopic prostatectomy on the collaborative-care pathway for open...

To define changes in the clinical pathway for open radical retropubic prostatectomy (RRP) and to determine their impact on patient care under the indirect influence of minimally invasive prostatectomy after implementing robotically assisted laparoscopic prostatectomy (RALP) at our institution and modifying the collaborative-care pathway.

We retrospectively reviewed the Vanderbilt Prostate Database since the initiation of RALP in May 2003, evaluating those patients who had open RRP. Data were analysed in three consecutive 5-month blocks to determine incremental changes in protocol and outcomes, including complications and re-admissions.

Between May 2003 and August 2004, 196 patients had RALP and 183 had RRP. After May 2003, there was a progressive reduction for open RRP in the length of stay from 1.6 to 1.3 days. Analysis also showed an elimination of patient-controlled analgesia, a rapid diet advancement, and drain removal at the surgeon's discretion. There were no major complications after surgery, and three minor complications (1.6%). The rate of re-admission after open RRP was low throughout the study period (seven patients, 3.8%), and did not increase progressively.

The management after open RRP was modified substantially after implementing RALP, with the two clinical pathways now similar. Despite these modifications in the treatment of patients having open RRP there was no increase in morbidity or compromise in patient outcome. Indeed, this study shows the feasibility and safety of a 1-day length of stay for open RRP.