scholarly journals Incidence and Risk Factors of Pulmonary Complications after Robot-Assisted Laparoscopic Prostatectomy: A Retrospective Observational Analysis of 2208 Patients at a Large Single Center

2019 ◽  
Vol 8 (10) ◽  
pp. 1509 ◽  
Author(s):  
Yu ◽  
Park ◽  
Kim ◽  
Kim ◽  
Hwang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
Single Center ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Steep Trendelenburg Position

Robot-assisted laparoscopic prostatectomy (RALP) is a minimally invasive technique for the treatment of prostate cancer. RALP requires the patient to be placed in the steep Trendelenburg position, along with pneumoperitoneum, which may increase the risk of postoperative pulmonary complications (PPCs). This large single-center retrospective study evaluated the incidence and risk factors of PPCs in 2208 patients who underwent RALP between 2014 and 2017. Patients were divided into those with (PPC group) and without (non-PPC group) PPCs. Postoperative outcomes were evaluated, and univariate and multivariate logistic regression analyses were performed to assess risk factors of PPCs. PPCs occurred in 682 patients (30.9%). Risk factors of PPCs included age (odds ratio [OR], 1.023; p = 0.001), body mass index (OR, 1.061; p = 0.001), hypoalbuminemia (OR, 1.653; p = 0.008), and positive end-expiratory pressure (PEEP) application (OR, 0.283; p < 0.001). The incidence of postoperative complications, rate of intensive care unit (ICU) admission, and duration of ICU stay were significantly greater in the PPC group than in the non-PPC group. In conclusion, the incidence of PPCs in patients who underwent RALP under pneumoperitoneum in the steep Trendelenburg position was 30.9%. Factors associated with PPCs included older age, higher body mass index, hypoalbuminemia, and lack of PEEP.

scholarly journals Intraoperative changes in whole-blood viscosity in patients undergoing robot-assisted laparoscopic prostatectomy in the steep Trendelenburg position with pneumoperitoneum: a prospective nonrandomized observational cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jung-Woo Shim ◽  
Hyun Kyung Moon ◽  
Yong Hyun Park ◽  
Misun Park ◽  
Jaesik Park ◽  
...  
Keyword(s):  
Shear Rate ◽  
Supine Position ◽  
Blood Viscosity ◽  
Whole Blood ◽  
Hematocrit Level ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Whole Blood Viscosity ◽  
Laparoscopic Prostatectomy ◽  
Steep Trendelenburg Position

Abstract Background The aim of this study was to investigate the effect of the steep Trendelenburg position (STP) with pneumoperitoneum on whole-blood viscosity (WBV) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). The study also analyzed the associations of clinical patient-specific and time-dependent variables with WBV and recorded postoperative outcomes. Methods Fifty-eight adult male patients (ASA physical status of I or II) undergoing elective RALP were prospectively analyzed in this study. WBV was intraoperatively measured three times: at the beginning of surgery in the supine position without pneumoperitoneum; after 30 min in the STP with pneumoperitoneum; and at the end of surgery in the supine position without pneumoperitoneum. The WBV at a high shear rate (300 s− 1) was recorded as systolic blood viscosity (SBV) and that at a low shear rate (5 s− 1) was recorded as diastolic blood viscosity (DBV). Systolic blood hyperviscosity was defined as > 13.0 cP at 300 s− 1 and diastolic blood hyperviscosity was defined as > 4.1 cP at 5 s− 1. Results The WBV and incidences of systolic and diastolic blood hyperviscosity significantly increased from the supine position without pneumoperitoneum to the STP with pneumoperitoneum. When RALP was performed in the STP with pneumoperitoneum, 12 patients (27.3%) who had normal SBV at the beginning of surgery and 11 patients (26.8%) who had normal DBV at the beginning of surgery developed new systolic and diastolic blood hyperviscosity, respectively. The degree of increase in WBV after positioning with the STP and pneumoperitoneum was higher in the patients with hyperviscosity than in those without hyperviscosity at the beginning of surgery. Higher preoperative body mass index (BMI) and hematocrit level were associated with the development of both systolic and diastolic blood hyperviscosity in the STP with pneumoperitoneum. All patients were postoperatively discharged without fatal complications. Conclusions Changes in surgical position may influence WBV, and higher preoperative BMI and hematocrit level are independent factors associated with the risk of hyperviscosity during RALP in the STP with pneumoperitoneum. Trial registration Clinical Research Information Service, Republic of Korea, approval number: KCT0003295 on October 25, 2018.

46 Impact of body mass index on the operative course and complications of robot assisted laparoscopic prostatectomy (RALP)

2011 ◽  
Vol 10 (8) ◽  
pp. 547-548 ◽  
Author(s):  
S.S. Rambaran ◽  
M. Kliffen ◽  
D. van den Ouden ◽  
D.C.D. Lange ◽  
R.P. Engel ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Robot Assisted ◽  
Laparoscopic Prostatectomy

scholarly journals Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review

2020 ◽  
pp. 75-89
Author(s):  
Ildar I. Lutfarakhmanov ◽  
I. A Melnikova ◽  
E. Yu Syrchin ◽  
V. F Asadullin ◽  
Yu. A Korelov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Prostatectomy ◽  
Gas Exchange ◽  
The Body ◽  
Cochrane Library ◽  
Chronic Obstructive ◽  
Positive End Expiratory Pressure ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Steep Trendelenburg Position

Introduction. Prostate cancer remains the most common urological malignancy, and robot-assisted radical prostatectomy (RARP) is the most effective treatment option. Special conditions for operation (Trendelenburg position and pneumoperitoneum) increase the airway pressure and reduce functional residual capacity of the lungs. Objectives. Review of risk factors for disorders and various interventions to improve pulmonary function and reduce the adverse physiological effects of RARP under general anesthesia. Materials and methods. This review of literature was conducted using the PubMed search engine in electronic databases Medline, Embase, the Cochrane Library and others up to May 2019. Results. A total of 22 studies were searched, including 9 randomized controlled trials. The factor that could worsen gas exchange during RARP was the body mass index 30 kg/m2. It is possible to improve gas exchange by means of recruitment maneuvers. Positive end-expiratory pressure of 5-10 cm H2O improves oxygenation but requires alertness in patients with chronic heart failure and chronic obstructive pulmonary disease. Conclusions. The main risk factors for perioperative respiratory and oxygenation disorders in RARP are pneumoperitoneum and steep Trendelenburg position. The effectiveness of ventilation regimes for the prevention of gas exchange disorders has not been proven. Using the recruitment maneuver and increasing the positive end-expiratory pressure does not improve the respiratory function of the lungs. Further studies with a longer follow-up period are needed to determine the clinical efficacy and safety of RARP.

scholarly journals Diaphragm Thickening Fraction as a Prognostic Imaging Marker for Postoperative Pulmonary Complications in Robot-Assisted Laparoscopic Prostatectomy Requiring the Trendelenburg Position and Pneumoperitoneum

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jihion Yu ◽  
Yongsoo Lee ◽  
Jun-Young Park ◽  
Jai-Hyun Hwang ◽  
Young-Kug Kim
Keyword(s):  
Roc Curve ◽  
Pulmonary Complications ◽  
Curve Analysis ◽  
Postoperative Pulmonary Complications ◽  
Robot Assisted ◽  
Roc Curve Analysis ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Formula Group ◽  
Respiratory Outcomes

Background. Robot-assisted laparoscopic prostatectomy (RALP) frequently entails postoperative pulmonary complications (PPCs) due to the Trendelenburg position and pneumoperitoneum. Diaphragm thickening fraction (TF) as an imaging marker can offer the advantage of predicting respiratory outcomes. Therefore, we evaluated the effect of diaphragm TF on the occurrence of PPCs in RALP. Methods. We measured the preoperative thickness of the diaphragm at peak inspiration ( T pi ) and end expiration ( T ee ) using ultrasonography. Diaphragm TF was calculated as TF = T pi – T ee / T ee . A receiver operating characteristic (ROC) curve analysis of TF was performed. After dividing patients into two groups according to the optimal TF cut-off value, we compared the occurrence of PPCs between the groups. The predictivity of diaphragm TF for the occurrence of PPCs was evaluated. Results. Of 145 patients, 40 patients (27.6%) developed PPCs. Patients with PPCs had a significantly lower TF than those without PPCs ( 0.31 ± 0.09 vs. 0.39 ± 0.11 , P < 0.001 ). In the ROC curve analysis, the optimal TF cut-off value was 0.28. The patients were divided into TF ≥ 0.28 group ( n = 114 ) and TF < 0.28 group ( n = 31 ). The incidence of PPCs was significantly higher in the TF < 0.28 group than in the TF ≥ 0.28 group (51.6% vs. 21.1%, P = 0.001 ). Diaphragm TF < 0.28 was associated with a higher incidence of PPCs than diaphragm TF ≥ 0.28 ( odds   ratio = 4.534 , 95% confidence interval [1.763–11.658], P = 0.002 ). Conclusion. Preoperative diaphragm TF < 0.28 was associated with an increased incidence of PPCs, suggesting that diaphragm TF as a prognostic imaging marker provides useful information on PPCs in RALP requiring the Trendelenburg position and pneumoperitoneum. Trial Registry Number. This trial is registered with KCT0005028.

scholarly journals Positive End-expiratory Pressure and Distribution of Ventilation in Pneumoperitoneum Combined with Steep Trendelenburg Position

2020 ◽  
Vol 132 (3) ◽  
pp. 476-490 ◽  
Author(s):  
Atsuko Shono ◽  
Nozomi Katayama ◽  
Tatsuya Fujihara ◽  
Stephan H. Böhm ◽  
Andreas D. Waldmann ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Mechanics ◽  
High Peep ◽  
Positive End Expiratory Pressure ◽  
Regional Ventilation ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Steep Trendelenburg Position ◽  
Postoperative Lung Function

Abstract Background Pneumoperitoneum and a steep Trendelenburg position during robot-assisted laparoscopic prostatectomy have been demonstrated to promote a cranial shift of the diaphragm and the formation of atelectasis in the dorsal parts of the lungs. However, neither an impact of higher positive end-expiratory pressure (PEEP) on preserving the ventilation in the dorsal region nor its physiologic effects have been fully examined. The authors hypothesized that PEEP of 15 cm H2O during robot-assisted laparoscopic prostatectomy might maintain ventilation in the dorsal parts and thus improve lung mechanics. Methods In this randomized controlled study, 48 patients undergoing robot-assisted laparoscopic prostatectomy were included in the analysis. Patients were assigned to the conventional PEEP (5 cm H2O) group or the high PEEP (15 cm H2O) group. Regional ventilation was monitored using electrical impedance tomography before and after the establishment of pneumoperitoneum and 20° Trendelenburg position during the surgery. The primary endpoint was the regional ventilation in the dorsal parts of the lungs while the secondary endpoints were lung mechanics and postoperative lung function. Results Compared to that in the conventional PEEP group, the fraction of regional ventilation in the most dorsal region was significantly higher in the high PEEP group during pneumoperitoneum and Trendelenburg position (mean values at 20 min after taking Trendelenburg position: conventional PEEP, 5.5 ± 3.9%; high PEEP, 9.9 ± 4.7%; difference, –4.5%; 95% CI, –7.4 to –1.6%; P = 0.004). Concurrently, lower driving pressure (conventional PEEP, 14.9 ± 2.5 cm H2O; high PEEP, 11.5 ± 2.8 cm H2O; P &lt; 0.001), higher lung dynamic compliance, and better oxygenation were demonstrated in the high PEEP group. Postoperative lung function did not differ between the groups. Conclusions Application of a PEEP of 15 cm H2O resulted in more homogeneous ventilation and favorable physiologic effects during robot-assisted laparoscopic prostatectomy but did not improve postoperative lung function. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2260
Author(s):  
Yu Jeong Bang ◽  
Heejoon Jeong ◽  
Burn Young Heo ◽  
Byung Seop Shin ◽  
Woo Seog Sim ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Nerve Sheath ◽  
Neurologic Deficits ◽  
Steep Trendelenburg Position

(1) Background: Robot-assisted laparoscopic prostatectomy (RALP) is preferred over open prostatectomy because it offers superior surgical outcomes and better postoperative recovery. The steep Trendelenburg position and pneumoperitoneum required in Robot-assisted laparoscopic prostatectomy, however, increase intracranial pressure (ICP). The present study aimed to evaluate the effects of elevated ICP on the quality of emergence from anesthesia. (2) Methods: Sixty-seven patients undergoing RALP were enrolled. We measured optic nerve sheath diameter at four timepoints during surgery. Primary outcome was inadequate emergence in the operating room (OR). Secondary outcomes were postoperative neurologic deficits of dizziness, headache, delirium, cognitive dysfunction, and postoperative nausea and vomiting (PONV). (3) Results: A total of 69 patients were screened for eligibility and 67 patients completed the study and were included in the final analysis. After establishing pneumoperitoneum with the Trendelenburg position, ONSD increased compared to baseline by 11.4%. Of the 67 patients, 36 patients showed an increase of 10% or more in optic nerve sheath diameter (ONSD). Patients with ΔONSD ≥ 10% experienced more inadequate emergence in the OR than those with ΔONSD < 10% (47.2% vs. 12.9%, p = 0.003). However, other variables related to the quality of emergence from anesthesia did not different significantly between groups. Similarly, neurologic deficits, and PONV during postoperative day 3 showed no significant differences. (4) Conclusions: ICP elevation detected by ultrasonographic ONSD measurement was associated with a transient, inadequate emergence from anesthesia.

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