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Setting new standards: robot-assisted radical prostatectomy as a day case

Prostate Cancer and Prostatic Diseases volume 28, pages 351–354 (2025)Cite this article

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Robot-assisted radical prostatectomy (RARP) has achieved the status of preferred surgical technique for prostate cancer (PCa) treatment in numerous healthcare settings worldwide [1]. The steadfast standardisation of the operative steps, coupled with a focused enhancements in patient recovery protocols, has improved surgical outcomes and has consistently reduced the length of stay (LOS). High volume meta-analyses have consistently shown low rates of major postoperative complications [2, 3]. Consequently, several parties are advocating for the safety of transitioning RARP to an outpatient surgery [4].

The first feasibility studies for same-day discharge (SDD) after RARP were aimed at establishing coherent operational protocols aligned with Enhanced Recovery After Surgery (ERAS) guidelines. These protocols included: usage of short-acting anaesthesia with reversal agent, opioid-free postoperative analgesia, early ambulation and early feeding. Patient selection was rigorous, limited to “fit” patients with low American Society of Anesthesiologists (ASA) scores, who were not on anticoagulants and lived in relative proximity to the hospital. To enhance safety and monitor early complications, patients were offered constant access to hospital caregivers and received a follow-up phone call within 24 h post-operation [5]. Faria et al. [6] conducted the first Randomised Controlled Trial (RCT) for SDD, applying strict inclusion criteria including ASA score ≤ 2, Gleason score ≤7, and no concurrent lymph node dissection (LND). Although 10 out of 24 patients randomised to SDD did not meet the discharge criteria primarily due to insecurity, pain, and nausea, there were no readmissions for postoperative complications. Similar SDD rates were also reported by Reddy et al. [7], with a 72.3% success rate for SDD, and failures mostly due to nausea, patient preference and pain.

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Author notes

  1. These authors contributed equally: Luca Orecchia, Georges Mjaess.

Authors and Affiliations

  1. Urology Unit, AOU Policlinico Tor Vergata, Rome, Italy

    Luca Orecchia & Simone Albisinni

  2. Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

    Georges Mjaess

  3. Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy

    Simone Albisinni

Authors
  1. Luca Orecchia
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  2. Georges Mjaess
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  3. Simone Albisinni
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Contributions

Conceptualization: SA, LO, GM; Writing—Original Draft: LO, GM; Writing—Review and Editing: SA.

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Correspondence to Luca Orecchia.

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Orecchia, L., Mjaess, G. & Albisinni, S. Setting new standards: robot-assisted radical prostatectomy as a day case. Prostate Cancer Prostatic Dis 28, 351–354 (2025). https://doi.org/10.1038/s41391-024-00856-6

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