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Anaesthetic management for robotic-assisted laparoscopic prostatectomy: the first UK national survey of current practice

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Abstract

Robotic-assisted laparoscopic prostatectomy (RALP) is the most common robotic surgical procedure, but there are little published data to inform anaesthetic practice. We aimed to characterise the range of anaesthetic practice for RALP in the United Kingdom through a national survey. We conducted an online national survey to determine current anaesthetic practice for RALP. The survey was distributed to all NHS hospitals within the UK that perform RALP. Thirty-four (79%) of 43 hospitals responded to the survey. Fourteen (41%) centres routinely provide spinal anaesthesia and 79% of these use diamorphine as their intrathecal opioid of choice. Thirty-one (91%) centres administer intravenous strong opioids intraoperatively, and a wide range of non-opioid analgesic agents are also administered. Five (15%) centres reported that they discharge a minority of patients on the day of surgery. High-volume centres are more likely to have a formalised enhanced recovery after surgery (ERAS) pathway and to provide ambulatory surgery for selected patients. This represents the first UK national survey of anaesthetic practice for RALP. The results of the survey revealed significant variation in anaesthetic practice implying a lack of consensus on best perioperative management.

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Acknowledgements

The authors acknowledge the NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Biomedical Research Centre. The authors would like to acknowledge the contribution of all respondents to the survey, and in particular the following respondents who also offered comments on the draft manuscript: Dr. Pamela Wake, Consultant Anaesthetist, Nottingham University Hospitals NHS Trust; Dr. Robert Orme, Consultant in Anaesthesia and Critical Care, Gloucestershire Hospitals NHS Foundation Trust; Dr. Richard Hughes, Consultant Anaesthetist, University Hospital of Wales; Dr. Charles Wallis, Consultant in Anaesthesia and Intensive Care, Western General Hospital; Dr. Chris Jones, Consultant Anaesthetist, Royal Surrey County Hospital.

Funding

The authors acknowledge the NHS funding to the Royal Marsden/Institute of Cancer Research NIHR Biomedical Research Centre. No grant was used to fund this study.

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Authors and Affiliations

  1. Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK

    D. Milliken, H. Lawrence, M. Brown, D. Cahill & R. Kasivisvanathan

  2. North Bristol NHS Trust, Bristol, UK

    D. Newhall

  3. Royal Berkshire Hospital NHS Foundation Trust, Reading, UK

    D. Barker

  4. South Tees NHS Foundation Trust, Middlesbrough, UK

    R. Ayyash

Authors
  1. D. Milliken
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  2. H. Lawrence
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  3. M. Brown
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  4. D. Cahill
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  5. D. Newhall
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  6. D. Barker
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  7. R. Ayyash
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  8. R. Kasivisvanathan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DM, HL, MB and RK. The first draft of the manuscript was written by DM. All authors commented on previous versions of the manuscript and made substantial contributions/edits to the text. All authors read and approved the final manuscript.

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Correspondence to D. Milliken.

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Conflict of interest

MB has undertaken paid consultancy work for Sativa Group Ltd, Spectrum Therapeutics and Senzer Ltd. No other author has any relevant interest to disclose.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research and development committee, and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

All survey participants consented to respond on an entirely voluntary basis and were informed prior to participation that the results of the survey would be published.

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Milliken, D., Lawrence, H., Brown, M. et al. Anaesthetic management for robotic-assisted laparoscopic prostatectomy: the first UK national survey of current practice. J Robotic Surg 15, 335–341 (2021). https://doi.org/10.1007/s11701-020-01105-3

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  • DOI: https://doi.org/10.1007/s11701-020-01105-3

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