Abstract
Background
Limited studies examined effects of pneumoperiotneum during robot-assisted radical
prostatectomy (RARP) and with AirSeal. The aim of this study was to assess the effect
on hemodynamics of a lower pressure pneumoperitoneum (8 mmHg) with AirSeal, during
RARP in steep Trendelenburg 45° (ST).
Materials and Methods
This is an institutional review board-approved, prospective, interventional, single-center
study including patients treated with RARP at OLV Hospital by one extremely experienced
surgeon (July 2015-February 2016). Intraoperative monitoring included: arterial pressure,
central venous pressure, cardiac output, heart rate, stroke volume, systemic vascular
resistance, intrathoracic pressure, airways pressures, left ventricular end-diastolic
and end-systolic areas/volumes and ejection fraction, by transesophageal echocardiography,
an esophageal catheter, and FloTrac/Vigileo system. Measurements were performed after
induction of anesthesia with patient in horizontal (T0), 5 minutes after 8 mmHg pneumoperitoneum
(TP), 5 minutes after ST (TT1) and every 30 minutes thereafter until the end of surgery
(TH). Parameters modification at the prespecified times was assessed by Wilcoxon and
Friedman tests, as appropriate. All analyses were performed by SPSS v. 23.0.
Results
A total of 53 consecutive patients were enrolled. The mean patients age was 62.6 ±
6.9 years. Comorbidity was relatively limited (51% with Charlson Comorbidity Index
as low as 0). Despite the ST, working always at 8 mmHg with AirSeal, only central
venous pressure and mean airways pressure showed a statistically significant variation
during the operative time. Although other significant hemodynamic/respiratory changes
were observed adding pneumoperitoneum and then ST, all variables remained always within
limits safely manageable by anesthesiologists.
Conclusion
The combination of ST, lower pressure pneumoperitoneum and extreme surgeon's experience
enables to safely perform RARP.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparison of a standard CO2 pressure pneumoperitoneum insufflator versus AirSeal: study protocol of a randomized controlled trial.Trials. 2014; 15: 239
- Laparoscopy in urology: physiologic considerations.in: Fallon B. Hospital Physician Urology Board Review Manual Volume 10, Part 2. Turner White Communications Inc, Wayne, PA2002: 1-20
- Esophageal Doppler (ODM II) improves intraoperative hemodynamic monitoring during laparoscopic surgery.Surg Laparosc Endosc Percutan Tech. 2005; 15: 332-338
- Simultaneous hemodynamic and echocardiographic changes during abdominal gas insufflation.Surg Laparosc Endosc. 1997; 7: 415-419
- Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis.Anesth Analg. 1996; 83: 482-487
- Cardiac function during intraperitoneal CO2 insufflation for aortic surgery: a transesophageal echocardiographic study.Anesth Analg. 2006; 102: 1304-1310
- Randomized clinical trial of the effect of pneumoperitoneum on cardiac function and haemodynamics during laparoscopic cholecystectomy.Br J Surg. 2004; 91: 848-854
- Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position.Anesth Analg. 2011; 113: 1069-1075
- Haemodynamic effects of CO2 pneumoperitoneum in elderly patients with an increased cardiac risk.Eur J Anaesthesiol. 1997; 14: 266-275
- Prospective comparison between the AirSeal® System valve-less Trocar and a standard Versaport™ Plus V2 Trocar in robotic-assisted radical prostatectomy.J Endourol. 2013; 27: 579-582
- Benchtop evaluation of pressure barrier insufflator and standard insufflator systems.Surg Endosc. 2013; 27: 333-338
- Fundamentals of laparoscopic and robotic urologic surgery, Volume I, Part II, Chapter 10.in: Wein A.J. Kavoussi L.R. Partin A.W. Peters C.A. Campbell-Walsh Urology 17th Edition. Elsevier, Philadelphia2016: 195-224
- AirSeal website.(Available at:) (Accessed: June 15, 2016)
- Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients.Crit Care Med. 1989; 17: 118-121
- Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair.Am Surg. 1989; 55: 396-402
- Hemodynamic effects of increased abdominal pressure.J Surg Res. 1981; 30: 249-255
- Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo.J Appl Physiol. 1991; 70: 2611-2618
- Hemodynamic effects following surgical release of increased intra-abdominal pressure.Br J Anaesth. 1987; 59: 800-805
- Hemodynamic changes during robotic radical prostatectomy.Saudi J Anaesth. 2012; 6: 213-218
- Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study.Int J Med Robot. 2007; 3: 312-315
- Laparoscopic pneumoperitoneum: impact of body habitus.J Laparoendosc Surg. 1994; 4: 385-391
- Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy.Br J Surg. 2000; 87: 1161-1165
- Early catheter removal after robot-assisted radical prostatectomy: surgical technique and outcomes for the Aalst technique (ECaRemA Study).Eur Urol. 2016; 69: 917-923
- Esophageal Pressure Measurement.in: Hamid Q. Joanne Shannon M.D. Martin J.G. Physiologic Basis of Respiratory Disease. BC Decker, Incorporated, Toronto2005: 639-647
- Improved technique for estimating pleural pressure from esophageal balloons.J Appl Physiol. 1964; 19: 207-211
- Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy.Br J Anaesth. 2010; 104: 433-439
- Haemodynamics and cardiac function during robotic-assisted laparoscopic prostatectomy in steep Trendelenburg position.Int J Med Robot. 2011; 7: 408-413
- Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy.J Clin Anesth. 2014; 26: 383-389
- Examining clinical outcomes utilizing low-pressure pneumoperitoneum during robotic-assisted radical prostatectomy.J Robot Surg. 2016; 10: 215-219
Article info
Publication history
Published online: June 02, 2017
Accepted:
May 25,
2017
Received in revised form:
May 16,
2017
Received:
March 29,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
