Outcomes of Minimally Invasive Urologic Surgery in the Elderly Patient Population
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GERIATRIC UROLOGY (TJ GUZZO, SECTION EDITOR)
Outcomes of Minimally Invasive Urologic Surgery in the Elderly Patient Population Simpa S. Salami & Arvin K. George & Soroush Rais-Bahrami
Published online: 20 March 2013 # Springer Science+Business Media New York 2013
Abstract The elderly patient is generally counseled with caution regarding open surgical procedures because of the relatively high morbidity and mortality associated when compared with similar procedures in younger patients without comorbidities. However, there is an ever-increasing utilization of minimally invasive surgical approaches to urological conditions with demonstrable benefits over open surgery in all patient populations, irrespective of age. We explore and present the various applications of minimally invasive surgery in urology, looking at the outcomes and current trends specifically as it applies to urologic surgery in elderly patients. Keywords Complications . Age . Laparoscopic . Robotic . Cystectomy . Nephrectomy . Nephroureterectomy . Prostatectomy . Oncologic
Introduction Minimally invasive surgery (MIS) has become a preferred management approach to various urological conditions, whether benign or malignant. MIS in urology began to take shape in 1990, when Clayman and colleagues reported performing the first successful laparoscopic nephrectomy [1]. In 1994, McDougall et al. reported their experience with laparoscopic procedures specifically in octogenarians [2]. Since then, the application of laparoscopy has become more and more popular in the field of urology, across all age S. S. Salami : A. K. George : S. Rais-Bahrami (*) The Arthur Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, 450 Lakeville Rd, Suite M-41, New Hyde Park, NY 11040, USA e-mail: [email protected]
groups and patient risk categories. Improvements in laparoscopic techniques, the development of the da Vinci robotic surgical system, and the relatively improved outcomes of these operative techniques have further popularized MIS compared to conventional open surgery. Some of the reported advantages of laparoscopy as compared to an open surgical approach for the same procedure includes: reduced postoperative pain, less analgesic requirement, early postoperative ambulation, faster return of bowel function, reduced length of hospital stay, improved cosmesis, and overall decreased convalescence period [3–5]. These benefits are especially welcomed in the management of the elderly patient population who are generally counseled with caution regarding open operative procedures given the relatively higher rates of morbidity and mortality associated with these procedures and the typically more tenuous baseline nutritional, pulmonary, and cardiovascular status of the elderly compared to their younger counterparts. Furthermore, advances in MIS techniques, anesthesia, and perioperative care have led to a reduction of operative risks and complications that has rendered surgery, even major operations a safer option in elderly patients. This is especial
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