title: Enhanced Recovery After Robot-assisted Radical Cystectomy: EAU Robotic Urology Section Scientific Working Group Consensus View.
abstract: Radical cystectomy (RC) is associated with frequent morbidity and prolonged length of stay (LOS) irrespective of surgical approach. Increasing evidence from colorectal surgery indicates that minimally invasive surgery and enhanced recovery programmes (ERPs) can reduce surgical morbidity and LOS. ERPs are now recognised as an important component of surgical management for RC. However, there is comparatively little evidence for ERPs after robot-assisted radical cystectomy (RARC). Due to the multimodal nature of ERPs, they are not easily validated through randomised controlled trials.
  
  
  
  To provide a European Association of Urology (EAU) Robotic Urology Section (ERUS) policy on ERPs to guide standardised perioperative management of RARC patients.
  
  
  
  The guidance was formulated in four phases: (1) systematic literature review of evidence for ERPs in robotic, laparoscopic, and open RC; (2) an online questionnaire survey formulated and sent to ERUS Scientific Working Group members; (3) achievement of consensus from an expert panel using the Delphi process; and (4) a standardised reporting template to audit compliance and outcome designed and approved by the committee.
  
  
  
  Consensus was reached in multiple areas of an ERP for RARC. The key principles include patient education, optimisation of nutrition, RARC approach, standardised anaesthetic, analgesic, and antiemetic regimens, and early mobilisation.
  
  
  
  This consensus represents the views of an expert panel established to advise ERUS on ERPs for RARC. The ERUS Scientific Working Group recognises the role of ERPs and endorses them as standardised perioperative care for patients undergoing RARC. ERPs in robotic surgery will continue to evolve with technological and pharmaceutical advances and increasing understanding of the role of surgery-specific ERPs.
  
  
  
  There is currently a lack of high-level evidence exploring the benefits of enhanced recovery programmes (ERPs) in patients undergoing robot-assisted radical cystectomy (RARC). We reported a consensus view on a standardised ERP specific to patients undergoing RARC. It was formulated by experts from high-volume RARC hospitals in Europe, combining current evidence for ERPs with experts' knowledge of perioperative care for robotic surgery.
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Collins
authors.affiliation: Department of Urology, University Hospital of Northern Norway, Tromsø, Norway.
authors.forename: Hiten
authors.initials: H
authors.lastname: Patel
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christofer
authors.initials: C
authors.lastname: Adding
authors.affiliation: Department of Urology, Stockholm Urology Clinic, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Annerstedt
authors.affiliation: Department of Urology, Guys Hospital, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Department of Urology, Guys Hospital, London, UK.
authors.forename: Shamim M
authors.initials: SM
authors.lastname: Khan
authors.affiliation: Department of Urology, Verona University Hospital, Verona, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Artibani
authors.affiliation: Clinique Saint Augustin, Bordeaux, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
authors.affiliation: Clinique Saint Augustin, Bordeaux, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Piechaud
authors.affiliation: Department of Urology, Sheffield University Hospital, Sheffield, UK.
authors.forename: James W
authors.initials: JW
authors.lastname: Catto
authors.affiliation: Department of Urology, Bristol Urological Institute, Bristol, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Koupparis
authors.affiliation: Department of Urology, Bristol Urological Institute, Bristol, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Rowe
authors.affiliation: Department of Urology, St Georges, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perry
authors.affiliation: Department of Urology, St Georges, London, UK.
authors.forename: Rami
authors.initials: R
authors.lastname: Issa
authors.affiliation: Department of Urology, Royal Devon and Exeter Hospital, Exeter, UK.
authors.forename: John
authors.initials: J
authors.lastname: McGrath
authors.affiliation: Department of Urology, UCL, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Department of Urology, Hirslanden Klinik, Aarau, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Department of Urology, Rijnstate, Arnhem, Netherlands.
authors.forename: Carl
authors.initials: C
authors.lastname: Wijburg
authors.affiliation: Department of Urology, Ankara Ataturk Hospital, Ankara, Turkey.
authors.forename: Abdullah E
authors.initials: AE
authors.lastname: Canda
authors.affiliation: Department of Urology, Memorial Sisli Hospital, Istanbul, Turkey.
authors.forename: Meviana D
authors.initials: MD
authors.lastname: Balbay
authors.affiliation: Department of Urology, Ghent University, Ghent, Belgium.
authors.forename: Karel
authors.initials: K
authors.lastname: Decaestecker
authors.affiliation: Department of Urology, University of Tuebingen, Tubingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.affiliation: Department of Urology, University of Tuebingen, Tubingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Department of Urology, Da Vinci Zentrum, Hanover, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Edeling
authors.affiliation: Department of Urology, Da Vinci Zentrum, Hanover, Germany.
authors.forename: Sasa
authors.initials: S
authors.lastname: Pokupić
authors.affiliation: Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stockle
authors.affiliation: Department of Urology, Universittatsklinikum des Saarlandes, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanchez-Salas
authors.affiliation: Department of Urology, L'Institut Mutualiste Montsouris, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.affiliation: Department of Urology, Royal Liverpool Hospital, Liverpool, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Weston
authors.affiliation: Department of Urology, Newcastle upon Tyne Hospitals, Newcastle, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Department of Urology, O.L.V, Aalst, Belgium.
authors.forename: Fredrik
authors.initials: F
authors.lastname: D'Hondt
authors.affiliation: Department of Urology, O.L.V, Aalst, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: Department of Urology, Karolinska University Hospital, Stockholm, Sweden. Electronic address: peter.wiklund@karolinska.se.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Wiklund
mesh_terms: D032921:Consensus; D015653:Cystectomy / Q000379:methods*; D004434:Early Ambulation; D006801:Humans; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D020127:Recovery of Function; D065287:Robotic Surgical Procedures
keywords: ERAS; Enhanced recovery after surgery; Enhanced recovery protocol; RARC; Radical cystectomy; Robot-assisted radical cystectomy