Low pressure robot-assisted radical prostatectomy with the AirSeal System at OLV hospital: results from a prospective study

Abstract Background Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy (RARP) and with AirSeal. To assess the effect on hemodynamics of a lower pressure pneumoperitoneum (LPP, 8 mmHg) with AirSeal, during RARP in steep Trendelenburg 45°(ST). Materials an...

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Published in:Clinical genitourinary cancer 2017-12, Vol.15 (6), p.e1029-e1037
Main Authors: La Falce, Sabrina, Novara, Giacomo, Gandaglia, Giorgio, Umari, Paolo, De Naeyer, Geert, D’Hondt, Frederiek, Beresian, Jean, Carette, Rik, Penicka, Martin, Mo, Yujiing, Vandenbroucke, Geert, Mottrie, Alexandre
Format: Article
Language:English
Subjects:
Aged
Blood Pressure
Hematology, Oncology and Palliative Medicine
Hemodynamics
Humans
Low impact surgery
Low pressure pneumoperitoneum
Male
Middle Aged
Monitoring, Intraoperative
Operative Time
Pneumoperitoneum - epidemiology
Pneumoperitoneum - etiology
Prospective Studies
Prostatectomy - adverse effects
Prostatectomy - instrumentation
RARP
Robotic Surgical Procedures - adverse effects
Steep Trendelenburg
Urology
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Summary:Abstract Background Limited studies examined effects of pneumoperiotneum during robot-assisted radical prostatectomy (RARP) and with AirSeal. To assess the effect on hemodynamics of a lower pressure pneumoperitoneum (LPP, 8 mmHg) with AirSeal, during RARP in steep Trendelenburg 45°(ST). Materials and Methods This is a IRB-approved, prospective, interventional, single-center study including patients treated with RARP at OLV Hospital by one extremely experienced surgeon (Jul 2015-Feb 2016). Intraoperative monitoring included: arterial pressure, central venous pressure (CVP), cardiac output, heart rate, stroke volume, systemic vascular resistance, intrathoracic pressure, airways pressures, left ventricular end-diastolic and end-systolic areas/volumes, 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-min after 8 mmHg pneumoperitoneum (TP), 5-min after ST (TT1), every 30 min thereafter until the end of surgery (TH). Parameters modification at the pre-specified times was assessed by Wilcoxon and Friedman tests, as appropriate. All analyses were performed by SPSS vers. 23.0. Results 53 consecutive patients were enrolled. 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 CVP 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, LPP and extreme surgeon’s experience allows to safely perform RARP.
ISSN:1558-7673
1938-0682
DOI:10.1016/j.clgc.2017.05.027