procedures in the out-
patient setting.
"We have a very
good system, in part
because we have two
full-time physician
assistants who talk to patients ahead of surgery and give them the
roadmap that outlines the course of their care," says Dr. Dobbs. "That
way, patients know what to expect leading up to surgery and also
know what potential post-op complications would necessitate giving
us a call for follow-up care."
Many patients still approach surgery with the mindset of having to
stay a couple of days in the hospital, according to Dr. Kaouk. He says
it's important to reset their expectations at the first clinic visit and
reinforce the message multiple times leading up to surgery. "When I
meet with patients scheduled for prostatectomies, I make sure they
understand the procedure is now commonly done in outpatient set-
tings," he says. "They're told the robot operates through a single small
incision, the procedure is not overly painful, and they'll be more com-
fortable recovering at home."
Optimizing fluid management and limiting the use of intraoperative
opioids are important factors in transitioning procedures to outpatient
facilities, points out Dr. Kaouk. Surgically, he limits dissection to the
immediate area around the prostate.
"We adopted a single-port technique and shifted from an intraab-
dominal to an extraperitoneal approach," he says. "I operate outside
the abdominal cavity, away from the bowel, which is not touched or
retracted, allowing for a quick return of bowel function after surgery."
Post-operative pain management involves giving patients nons-
teroidal anti-inflammatories such as ibuprofen instead of Percocet.
8 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
It would be unimaginable to
safely discharge patients on the day
of surgery without the robot.
— Ryan Dobbs, MD
