Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It’s effects on hemodynamic parameters and respiratory mechanics

• Published in: Journal of robotic surgery Vol. 17; no. 3; pp. 933 - 940
• Main Authors: Emir, Nalan Saygı, Akyol, Duygu, Sabaz, Mehmet Süleyman, Karadağ, Serdar
• Format: Journal Article
• Language: English
• Published: London Springer London 01.06.2023; Springer Nature B.V
• Subjects: Abdomen; Anesthesia; Anesthesiology; Blood; Blood pressure; Cancer surgery; Carbon dioxide; Carbon Dioxide - pharmacology; Cardiovascular disease; Chronic obstructive pulmonary disease; Comorbidity; Compliance; Coronary vessels; Diabetes; Gases; Hemodynamics; Humans; Hypertension; Intraabdominal surgery; Laparoscopy; Lungs; Male; Mechanics; Mechanics (physics); Medicine; Medicine & Public Health; Minimally Invasive Surgery; Normal distribution; Original Article; Oxygen saturation; Parameters; Patients; Prostate cancer; Prostatectomy - methods; Prostatic Neoplasms - surgery; Respiratory Mechanics; Retrospective Studies; Robotic Surgical Procedures - methods; Robotics; Robots; Statistical analysis; Surgery; Urological surgery; Urology; Vein & artery diseases; United States > US; Robotic assisted laparoscopic prostatectomy; insufflation; Deep trendelenburg; CO; Robotic assisted perineal prostatactomy; CO2 insufflation
• ISSN: 1863-2491; 1863-2483; 1863-2491
• DOI: 10.1007/s11701-022-01482-x

Robotic-assisted perineal prostatactomy(RAPP) is a new alternative surgical technique, in prostate cancer patients especially with a history of intra-abdominal surgery. The aim of this study is to examine the effects of the challenging patient position and CO 2 insufflation in perineal space during RAPP on both hemodynamic parameters and respiratory mechanics. Hemodynamic and respiratory parameters of 30 patients who underwent RAPP and 31 patients who underwent Robotic-assisted laparoscopic prostatectomy (RALP) for prostate cancer between 2017 and 2019 were retrospectively evaluated. Comparison between RAPP and RALP patients showed that anesthesia, surgery and insufflation times were shorter in RAPP patients ( p  < 0.05). Blood pCO 2 level was higher, and the pH decrease was more prominent in the RAPP patients 30 and 60 min after perineal CO 2 insufflation ( p  < 0.05). The mean arterial pressures, driving pressure, Ppeak and Pplato values were statistically higher in the RALP patients and 60 min after insufflation while static and dynamic lung compliance values were found to be lower. Our results showed that blood pCO 2 level may severely increase after perineal CO 2 insufflation. The fact that respiratory mechanics are less affected despite the difficult patient position for lungs in RAPP patients, the presence of higher CO 2 level supports that the perineal CO 2 insufflation plays a more important role in increased CO 2 level. Considering these changes, especially the sudden increase in the risk of CO 2 level, close follow-up and timely intervention by anesthesiology can ensure all changes remain in a clinically safe range.