Intraoperative management of robotic-assisted versus open radical prostatectomy

Daniel M Gainsburg, David Wax, David L Reich, John R Carlucci, David B Samadi, Daniel M Gainsburg, David Wax, David L Reich, John R Carlucci, David B Samadi

Abstract

Background and objectives: Minimally invasive surgery has been shown to decrease postoperative morbidity and length of stay for several laparoscopic procedures. We sought to retrospectively compare intraoperative surgical and anesthetic parameters, post-anesthetic care unit (PACU) length of stay, and hospital length of stay of patients who underwent robotic-assisted laparoscopic radical prostatectomy (RAP) versus open radical retropubic prostatectomy (ORP).

Methods: A retrospective investigation was performed using a urologic surgery database and an anesthesia electronic medical record. We queried information regarding 106 ORP patients from 2002 through 2007 and 575 RAP patients from 2007 through 2008.

Results: Patients in the RAP group compared with ORP patients had reductions in surgical time, anesthesia time, estimated blood loss, crystalloid administration, and PACU and hospital length of stays. Compared with ORP procedures, intraoperative respiratory rates, peak inspiratory pressures, and arterial pressures in RAP procedures were higher; tidal volumes and heart rates were decreased; but end-tidal carbon dioxide concentrations were not different. In the RAP group, intraoperative complications included severe bradycardia, corneal abrasions, and 2 patients required reintubation. Surgically, no rectal perforations were noted, and no operative mortalities occurred.

Conclusions: Our data demonstrate the safety and efficacy of RAP due to a combination of surgical and anesthetic factors.

References

    1. Martínez-Salamanca JI, Romero Otero J. Critical comparative analysis between open, laparoscopic and robotic radical prostatectomy: perioperative morbidity and oncological results (Part I). Arch Esp Urol. 2007;60(7):755–765
    1. Okabe T, Kim C, Yamanashi Y, Sakamoto A. Anesthesia management for laparoscopic prostatectomy and open prostatectomy. Masui. 2007;56(12):1404–1407 Japanese
    1. Danic MJ, Chow C, Alexander G, et al. Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases. J Robotic Surg. 2007;1(2):119–123
    1. Phong SN, Koh LD. Anaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position. Anaesth Intensive Care. 2007;35(2):281–285
    1. Nelson B, Kaufman M, Broughton G, et al. Comparison of length of hospital stay between radical retropubic prostatectomy and robotic assisted laparoscopic prostatectomy. J Urol. 2007;177(3):929–931
    1. Farnham SB, Webster TM, Herrell SD, Smith JA., Jr Intraoperative blood loss and transfusion requirements for robotic-assisted radical prostatectomy versus radical retopubic prostatectomy. Urology. 2006;67(2):360–363
    1. Tewari A, Srivasatava A, Menon M. Members of the VIP Team. A prospective comparison of radical retropubic and robotic-assisted prostatectomy: experience in one institution. BJU Int. 2003;92(3):205–210
    1. Menon M, Tewari A, Baize B, et al. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002;60:864–868
    1. Falabella A, Moore-Jeffries E, Sullivan M, et al. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study. Int J Med Robotics Comput Assist Surg. 2007;3(4):312–315
    1. Costello TG, Webb P. Anaesthesia for robot-assisted anatomic prostatectomy. Experience at a single institution. Anaesth Intensive Care. 2006;34(6):787–792
    1. Stolzenburg JU, Aedtner B, Olthoff D, et al. Anaesthetic considerations for endoscopic extraperitoneal and paroscopic transperitoneal radical prostatectomy. BJU Int. 2006;98(3):508–513 Review
    1. Meininger D, Zwissler B, Byhahn C, Probst M, Westphal K, Bremerich DH. Impact of overweight and pneumoperitoneum on hemodynamics and oxygenation during prolonged laparoscopic surgery. World J Surg. 2006;30(4):520–526
    1. Choi SJ, Gwak MS, Ko JS, et al. The effects of the exaggerated lithotomy position for radical perineal prostatectomy on respiratory mechanics. Anaesthesia. 2006;61(5):439–443
    1. Ryniak S, Brännstedt S, Blomqvist H. Effects of exaggerated lithotomy position on ventilation and hemodynamics during radical perineal prostatectomy. Scand J Urol Nephrol. 1998;32(3):200–203
    1. Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996;110(3):810–815
    1. Wahba RWM, Beique F, Kleiman SJ. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesthiol. 1995;42(1):51–63
    1. Joris JL, Noirot DP, Legrand MJ, et al. Haemodynamic changes during laparoscopic cholecystectomy. Anesth Analg. 1993;76(5):1067–1071
    1. Branche PE, Duperret SL, Sagnard PE, et al. Left ventricular loading modifications induced by pneumoperitoneum: a time course echocardiographic study. Anesth Analg. 1998;86(3):482–487
    1. Reich DL, Wood RK, Mattar R, et al. Arterial blood pressure and heart rate discrepancies between handwritten and computerized anesthesia records. Anesth Analg. 2000;91(3):612–616
    1. Reed DN, Jr, Duff JL. Persistent occurrence of bradycardia during laparoscopic cholecystectomies in low-risk patients. Dig Surg. 2000;17(5):513–517
    1. Bhandari A, McIntire L, Kaul SA, Hemal AK, Peabody JO, Menon M. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 2005;174(3):915–918
    1. Patel VR, Palmer KJ, Couglin G, Samavedi S. Robot-assisted laparoscopic radical prostatectomy: perioperative outcomes of 1500 cases. J Endourol. 2008;22(10):2299–2305
    1. Fischer B, Engel N, Fehr JL, John H. Complications of robotic assisted radical prostatectomy. World J Urol. 2008;26(6):595–602

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅