Clinical Research Of Enhanced Recovery After Surgery In Robot-assisted Laparoscopic Radical Prostatectomy

Objective:To systematically evaluate the clinical research of perioperative enhanced recovery after surgery(ERAS)in patients undergoing Da Vinci robot-assisted radical prostatectomy(RARP),and the application effect of ERAS mode combined with different surgical approaches were compared further for exploring its safety and efficacy in clinical practice.Methods:A total of 94 patients who received Da Vinci robot-assisted laparoscopic radical prostatectomy in the Department of Urology of our hospital from December 2016 to December 2019 were selected according to the inclusion and exclusion criteria.The baseline information of the selected patients was collected and divided into the ERAS group(using the ERAS mode)and the traditional group(using the traditional mode)according to different perioperative management methods.The ERAS group was further stratified and analyzed according to different approach methods.SPSS 23.0software was used to analyze and compare the differences of intra-group in preoperative basic informations,intraoperative surgical datas and postoperative recovery related indicators of patients and the differences in intraoperative and postoperative indicators of patients in inter-group.Results:The two groups of patients were successfully completed the operation and discharged normally.There was no significant difference in age,body mass index(BMI),prostate volume,preoperative serum prostate specific antigen(PSA),preoperative hemoglobin,white blood cells,clinical stage,puncture Gleason score,number of puncture positive needles,previous abdominal surgery history,operation time and intraoperative blood loss between the two groups(P > 0.05).In the comparison of postoperative catheter indwelling time,drainage tube indwelling time,pain degree,first activity and exhaust time,hospital stay and cost,the ERAS group was less than the traditional group,and the difference had statistical significance(P <0.05).However,there was no statistically significant difference in Clavien score,postoperative Gleason score,pathological stage,laboratory parameters and surgical margins and lymph node positivity between the two groups(P > 0.05).In the experimental group,the RARP transvesical approach was less than the anterior approach group in terms of intraoperative blood loss,postoperative catheter indwelling time,drainage tube indwelling time,first activity time and first exhaust time,and the differences were statistically significant(P < 0.05),but there was no significant statistical difference between the two groups in terms of operation time,pain score,postoperative complications and total hospital stay(P > 0.05).Conclusions:1.The application of fast-track surgery in the perioperative period of robot-assisted laparoscopic radical prostatectomy is safe and feasible,not only can shorten the hospital stay and reduce hospitalization costs,but also can relieve postoperative pain and decrease the occurrence of postoperative complications,thereby promoting the early recovery of patients.2.The concept of fast-track surgery combined with RARP transvesical approach can further reduce the patient’s body injury,improve postoperative urinary control,expand the advantages of minimally invasive surgery to accelerate the rehabilitation of patients,which is worthy of clinical application.