Same-day discharge robot-assisted laparoscopic prostatectomy: feasibility, safety and patient experience.

OBJECTIVES: To report a single centre's experience of the feasibility, safety and patient acceptability of same-day discharge robot-assisted laparoscopic prostatectomy (RALP). SUBJECTS/PATIENTS AND METHODS: Between June 2015 and December 2021, a total of 180 pre-selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same-day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. RESULTS: Of 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63 ( 44-74) years. The median (range) console time was 97 (61-256) min and blood loss was 200 (20-800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2-3 and 8.4% had GGG 4-5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (<90 days) biochemical relapses (defined as prostate-specific antigen level >0.2 ng/mL). The 30-day readmission rate was 3%. A total of 13 early (0-30 days) complications were observed, five of which were Clavien-Dindo grade ≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. CONCLUSION: Robot-assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well-liked by patients, with morbidity and oncological outcomes similar to non-day-case or 23 h stay RALP.

A voltage-dependent K+ current contributes to membrane potential of acutely isolated canine articular chondrocytes.

The electrophysiological properties of acutely isolated canine articular chondrocytes have been characterized using patch-clamp methods. The 'steady-state' current-voltage relationship (I-V) of single chondrocytes over the range of potentials from -100 to +40 mV was highly non-linear, showing strong outward rectification positive to the zero-current potential. Currents activated at membrane potentials negative to -50 mV were time independent, and the I-V from -100 to -60 mV was linear, corresponding to an apparent input resistance of 9.3 +/- 1.4 G Omega (n= 23). The outwardly rectifying current was sensitive to the K(+) channel blocking ion tetraethylammonium (TEA), which had a 50% blocking concentration of 0.66 mM (at +50 mV). The 'TEA-sensitive' component of the outwardly rectifying current had time- and membrane potential-dependent properties, activated near -45 mV and was half-activated at -25 mV. The reversal potential of the 'TEA-sensitive' current with external K(+) concentration of 5 mm and internal concentration of 145 mM, was -84 mV, indicating that the current was primarily carried by K(+) ions. The resting membrane potential of isolated chondrocytes (-38.1 +/- 1.4 mV; n= 19) was depolarized by 14.8 +/- 0.9 mV by 25 mM TEA, which completely blocked the K(+) current of these cells. These data suggest that this voltage-sensitive K(+) channel has an important role in regulating the membrane potential of canine articular chondrocytes.