Jean-Christophe Bernhard1,2, Grégoire Robert3, Solène Ricard3,4, Clément Michiels3, Grégoire Capon3, Astrid Boulenger de Hautecloque3, Henri Bensadoun3, Joséphine Gay3,4, Julien Rogier5, Patrick Tauzin-Fin5, Marine Gross-Goupil6, Antoine Benard7, Karine Nouette5, Stéphanie Roullet5, Jean-Marie Ferrière3. 1. Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France. Jean-christophe.bernhard@chu-bordeaux.fr. 2. French Research Network on Kidney Cancer UroCCR, Bordeaux, France. Jean-christophe.bernhard@chu-bordeaux.fr. 3. Department of Urology, University Hospital of Bordeaux, CHU Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux Cedex, France. 4. French Research Network on Kidney Cancer UroCCR, Bordeaux, France. 5. Department of Anesthesiology, University Hospital of Bordeaux, Bordeaux, France. 6. Department of Medical Oncology, University Hospital of Bordeaux, Bordeaux, France. 7. Methodology Unit, Public Health Department, University Hospital of Bordeaux, Bordeaux, France.
Abstract
PURPOSE: Robotic partial nephrectomy (RPN) is a minimally-invasive technique used to treat renal tumors. A clinical pathway and prospective research protocol (AMBU-REIN) were specifically set up to establish and assess the routine use of day-case RPN. METHODS: The AMBU-REIN study was conducted in the framework of the French research network on kidney cancer UroCCR (NCT03293563). We present our initial experience of patients treated using day-case RPN and released from our hospital on the same day, focusing on patient selection, safety and patient satisfaction using the EVAN-G validated questionnaire. RESULTS: Between September 2016 and September 2019, 429 RPN were performed and 82 patients were consecutively selected for day-case RPN. Patients were managed using transperitoneal RPN with off-clamp tumorectomy for 66/82 cases. Mean tumor size was 2.7 ± 1.2 cm. There were no immediate severe postoperative complications; 7/82 patients were kept under observation overnight and discharged the following day. The follow-up at day 30 indicated postoperative complications, readmissions, and mortality rates of 1.2, 1.2, and 0%, respectively. Next-day patient satisfaction questionnaires indicated that patients were generally highly satisfied, with a mean ± standard deviation global score of 83.6 ± 10.3%. "Attention" was rated the highest overall (mean 94.8 ± 10.5%), while "pain management" scored the lowest (61.2 ± 20.5%). CONCLUSIONS: This prospective case series is the first to demonstrate the safety and feasibility of day-case RPN. For selected patients and through a dedicated, nurse-led clinical pathway, it provided a high level of patient satisfaction. Expected benefits on healthcare cost savings warrant further investigation.
PURPOSE: Robotic partial nephrectomy (RPN) is a minimally-invasive technique used to treat renal tumors. A clinical pathway and prospective research protocol (AMBU-REIN) were specifically set up to establish and assess the routine use of day-case RPN. METHODS: The AMBU-REIN study was conducted in the framework of the French research network on kidney cancer UroCCR (NCT03293563). We present our initial experience of patients treated using day-case RPN and released from our hospital on the same day, focusing on patient selection, safety and patient satisfaction using the EVAN-G validated questionnaire. RESULTS: Between September 2016 and September 2019, 429 RPN were performed and 82 patients were consecutively selected for day-case RPN. Patients were managed using transperitoneal RPN with off-clamp tumorectomy for 66/82 cases. Mean tumor size was 2.7 ± 1.2 cm. There were no immediate severe postoperative complications; 7/82 patients were kept under observation overnight and discharged the following day. The follow-up at day 30 indicated postoperative complications, readmissions, and mortality rates of 1.2, 1.2, and 0%, respectively. Next-day patient satisfaction questionnaires indicated that patients were generally highly satisfied, with a mean ± standard deviation global score of 83.6 ± 10.3%. "Attention" was rated the highest overall (mean 94.8 ± 10.5%), while "pain management" scored the lowest (61.2 ± 20.5%). CONCLUSIONS: This prospective case series is the first to demonstrate the safety and feasibility of day-case RPN. For selected patients and through a dedicated, nurse-led clinical pathway, it provided a high level of patient satisfaction. Expected benefits on healthcare cost savings warrant further investigation.
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Authors: Clément Michiels; Zine-Eddine Khene; Thomas Prudhomme; Astrid Boulenger de Hauteclocque; François H Cornelis; Mélanie Percot; Hélène Simeon; Laure Dupitout; Henri Bensadoun; Grégoire Capon; Eric Alezra; Vincent Estrade; Franck Bladou; Grégoire Robert; Jean-Marie Ferriere; Nicolas Grenier; Nicolas Doumerc; Karim Bensalah; Jean-Christophe Bernhard Journal: World J Urol Date: 2021-04-02 Impact factor: 4.226