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Pushing For Change - July 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 87 of 110

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

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