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Gill RK, Gupta A, Kaur P, Sidhu B, Saxena P, Saini NS, Gupta M. The Effect of Pneumoperitoneum on the Ankle-brachial Index of the Patients Undergoing Laparoscopic Cholecystectomy: An Observational Study. Int J Appl Basic Med Res 2024; 14:94-100. [PMID: 38912362 PMCID: PMC11189268 DOI: 10.4103/ijabmr.ijabmr_498_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 06/25/2024] Open
Abstract
Background Improvement in the perioperative care has led to increased use of minimally invasive surgeries. Multiple physiological changes during minimally invasive surgeries are attributed to the creation of pneumoperitoneum. Materials and Methods One hundred and nine patients who underwent laparoscopic cholecystectomy at a tertiary care hospital in north India meeting the inclusion and exclusion criteria were enrolled. Results Out of the total 109 patients, 13 were males and 96 females (M:F = 1:7.3), the mean basal metabolic rate was 28.95 kg/m2. The mean systolic and diastolic blood pressure of the upper limb were 134.33 + 17.545 and 80.69 + 11.59 respectively. The mean systolic and diastolic blood pressure in lower limb (LL) were 142.32 + 21.552 and 79.44 + 11.94, respectively. Significant rise in the SBP was noticed in LL at the time of creation of Pneumoperitoneum and after changing the position for surgery (P < 0.05). The diastolic pressure in the LL rises significantly in the LL after creation of pneumoperitoneum, at induction, after reverse Trendelenburg position and extubation (P < 0.05). The mean arterial pressure increased significantly in the LL after the creation of pneumoperitoneum and persisted till the extubation (P < 0.05). A significant rise of ankle-brachial index (ABI) was observed in the patients after the creation of pneumoperitoneum and it remained significant till 15 min into surgery (P < 0.05). There was no correlation of ABI with weight and age of the patients on Pearson correlation. Conclusion There is rise in ABI of the patients undergoing laparoscopic cholecystectomy at the time of creation of pneumoperitoneum, after Trendelenburg position and 15 min into surgery.
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Affiliation(s)
| | - Ashish Gupta
- Department of General Surgery, AIMS, Mohali, Punjab, India
| | - Prabhjot Kaur
- Department of General Surgery, AIMS, Mohali, Punjab, India
| | - Bharti Sidhu
- Department of Anesthesia, AIMS, Mohali, Punjab, India
| | - Puja Saxena
- Department of Anesthesia, AIMS, Mohali, Punjab, India
| | | | - Money Gupta
- Department of General Surgery, AIMS, Mohali, Punjab, India
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Chiumello D, Fratti I, Coppola S. The intraoperative management of robotic-assisted laparoscopic prostatectomy. Curr Opin Anaesthesiol 2023; 36:657-665. [PMID: 37724574 DOI: 10.1097/aco.0000000000001309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy. RECENT FINDINGS Surgical innovations and the advent of new technologies make it imperative to optimize the anesthesia management to provide the most holistic approach possible. In addition, an ageing population with an increasing burden of comorbidities requires multifocal attention to reduce the surgical stress. SUMMARY Total intravenous anesthesia (TIVA) and balanced general anesthesia are similar in terms of postoperative complications and hospital stay. Reversal of rocuronium is associated with shorter hospital stay and postanesthesia recovery time. Adequate PEEP levels improve oxygenation and driving pressure, and the use of a single recruitment maneuver after the intubation reduces postoperative pulmonary complications. Restrictive intravenous fluid administration minimizes bladder-urethra anastomosis complications and facial edema. TIVA maintains a better autoregulation compared with balanced general anesthesia. Anesthesiologists should be able to optimize the intraoperative management to improve outcomes.
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Affiliation(s)
- Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan
- Department of Health Sciences
- Coordinated Research Center on Respiratory Failure, University of Milan, Italy
| | | | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan
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Kılınç E, Yildirim SA, Ulugöl H, Büyüköner EE, Güçyetmez B, Toraman F. The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. Front Med (Lausanne) 2023; 10:1273180. [PMID: 37822468 PMCID: PMC10563763 DOI: 10.3389/fmed.2023.1273180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Objective This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. Design A prospective, observational study. Setting Single center. Participants Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. Measurements and main results All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Conclusion Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.
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Affiliation(s)
- Emir Kılınç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Serap Aktas Yildirim
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halim Ulugöl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Elif Eroğlu Büyüköner
- Department of Cardiology, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Bülent Güçyetmez
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
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Lombardo AM, Gundeti MS. Review of robot-assisted laparoscopic surgery in management of infant congenital urology: Advances and limitations in utilization and learning. Int J Urol 2023; 30:250-257. [PMID: 36520939 DOI: 10.1111/iju.15105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
As robotic-assisted (RAL) surgery expanded to treat pediatric congenital disease, infant anatomy and physiology posed unique challenges that prompted adaptations to the technology and surgical technique, which are compiled and reviewed in this manuscript. From the beginning, collaboration with anesthesia is critical for a safe, efficient case including placement of an endotracheal tube rather than a laryngeal mask (LMA) and placement of a nasogastric tube and/or rectal tube to relieve distended stomach or bowel, respectively. Furthermore, end-tidal CO2 (EtCO2 ) is important for monitoring and predicting the effects of pneumoperitoneum on caridiovascular physiology, incranial pressure, and risk of acidosis and hypercarbia. Positioning can further exacerbate these effects and affect intra-abdominal working space. For infant robotic pyeloplasty and heminephrectomy, a "beanbag" is commonly used for stabilization in the lateral decubitus position. We advise against the use of a "baby bump" because it brings the bowels and vasculature more anterior than expected. Pnuemoperitoneum pressure of 8-10 mmHg during port placement maximizes safety, but thereafter, the pneumoperitoneum pressure can be minimized to 6-8 mmHg during the procedure without compromising the visual field. Port sites should be marked after insufflation, followed by the open Hasson technique for peritoneal access and port placement under direct vision with intussusception of the trocars to avoid vascular or bowel injury. Additional tips can be obtained through this manuscript, immersive fellowships, and mini-fellowships. Ulitmately, infant robotic surgery has the potential to benefit many children but is presently limited by the lack of pediatric-specific robotic technology and its associated costs.
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Affiliation(s)
- Alyssa M Lombardo
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mohan S Gundeti
- The University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
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Nakazawa K, Kodaira A, Matsumoto R, Matsushita T, Yoshikawa R, Ishida Y, Uchino H. Positive end-expiratory pressure setting based on transpulmonary pressure during robot-assisted laparoscopic prostatectomy: an observational intervention study. JA Clin Rep 2022; 8:10. [PMID: 35150377 PMCID: PMC8840948 DOI: 10.1186/s40981-022-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In robot-assisted laparoscopic prostatectomy (RALP), concerns include the formation of atelectasis and reduced functional residual capacity. The present study aimed to examine the feasibility of positive end-expiratory pressure (PEEP) setting based on transpulmonary pressure (Ptp) as well as the effects of incremental PEEP on respiratory mechanics, blood gases, cerebral oxygenation (rSO2), and hemodynamics. Methods Fourteen male patients who were scheduled to receive RALP were recruited. Patients received mechanical ventilation (tidal volume of 6 mL kg−1) and were placed in Trendelenburg position with positive-pressure capnoperitoneum. PEEP levels were increased from 0 to 15 cmH2O (5 cmH2O per increase) every 30 min. PEEP levels were assessed where end-expiratory Ptp levels of ≥0 cmH2O were achieved (PtpEEP0). Airway pressure, esophageal pressure, cardiac index, and blood gas and rSO2 values were measured after 30 min at each PEEP step and respiratory mechanics were calculated. Results With increasing PEEP levels from 0 to 15 cmH2O or PtpEEP0, the values of PaO2 and respiratory system compliance increased, and the values of driving pressure decreased. The median PEEP level associated with PtpEEP0 was 15 cmH2O. Respiratory system compliance values were higher at PtpEEP0 than those at PEEP5 (P = 0.02). Driving pressure was significantly lower at PtpEEP0 than at PEEP5 (P = 0.0036). The cardiac index remained unchanged, and the values of rSO2 were higher at PtpEEP0 than at PEEP0 (right; P = 0.0019, left; P = 0.036). Conclusions PEEP setting determined by transpulmonary pressure can help achieve higher respiratory system compliance values and lower driving pressure without disturbing hemodynamic parameters.
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Affiliation(s)
- Koichi Nakazawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan.
| | - Ami Kodaira
- Department of Anesthesia, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Rika Matsumoto
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Tomoko Matsushita
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Ryotaro Yoshikawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Yusuke Ishida
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Hiroyuki Uchino
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
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Scarcella S, Castellani D, Piazza P, Giulioni C, Sarchi L, Amato M, Bravi CA, Lores MP, Farinha R, Knipper S, Palagonia E, Skrobot SA, Develtere D, Berquin C, Sinatti C, Van Puyvelde H, De Groote R, Umari P, De Naeyer G, Dell'Atti L, Milanese G, Puliatti S, Teoh JYC, B Galosi A, Mottrie A. Concomitant robot-assisted laparoscopic surgeries for upper and lower urinary tract malignancies: a comprehensive literature review. J Robot Surg 2021; 16:991-1005. [PMID: 34748165 DOI: 10.1007/s11701-021-01317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/03/2021] [Indexed: 12/24/2022]
Abstract
Worldwide, we have witnessed an expansion of robot-assisted laparoscopic surgery (RALS) and thanks to the global adoption of high-resolution diagnostic imaging technologies, an increased incidence of newly diagnosed prostatic, renal and bladder cancers has been recorded with concurrent second primary urological cancer diagnoses increasing by 1.5%. Diverse authors have reported their findings concerning synchronous multi-visceral malignances robotic treatment within the scientific literature. The aim of this study is to comprehensively review all reported articles describing concurrent upper and lower RALS using a singular robotic port scheme within the same intervention for renal malignances and concomitant prostatic or bladder cancers. To the best of our knowledge and vigorous literature search, this is the first study that comprehensively evaluates and reports all combined upper and lower urinary tract surgeries published so far. In carefully selected patients, thanks to multidisciplinary preoperative assessment and surgical planning a combined robotic approach can reduce the morbidity, complications, hospital admissions and the overall length of hospitalization.
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Affiliation(s)
- Simone Scarcella
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy.
| | - Daniele Castellani
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Luca Sarchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Amato
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Division of Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Peraire Lores
- Department of Urology, Son Espases University Hospital, Palma de Mallorca, Spain
| | | | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Erika Palagonia
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | | | - Dries Develtere
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Céline Sinatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Paolo Umari
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Lucio Dell'Atti
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Giulio Milanese
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea B Galosi
- Department of Urology, Polytechnic University of Marche Region, Umberto I Hospital "Ospedali Riuniti", 71 Conca Street, 60126, Ancona, Italy
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.,ORSI Academy, Melle, Belgium
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Kim HY, Lee SY, Lee HS, Jun BK, Choi JB, Kim JE. Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial. Adv Ther 2021; 38:1701-1712. [PMID: 33611742 DOI: 10.1007/s12325-021-01643-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Robotic radical prostatectomy requires prolonged pneumoperitoneum and a steep Trendelenburg position. Magnesium can attenuate the stress response and hemodynamic perturbations. This study aimed to evaluate the effects of intravenous magnesium administration on hemodynamics and the stress response in patients undergoing robotic radical prostatectomy. METHODS In this prospective, double-blind, randomized controlled study, 52 patients undergoing robotic radical prostatectomy were randomized into two groups: 26 in the magnesium group and 26 in the control group. The patients in the magnesium group received magnesium sulfate 50 mg/kg intravenously, followed by infusion at a rate of 10 mg/kg/h during surgery. The patients in the control group received an equal volume of 0.9% saline. The primary outcomes were the changes in heart rate and mean arterial pressure (MAP) during surgery. The serum stress hormones (adrenocorticotropic hormone, cortisol, epinephrine, and norepinephrine) were also measured. RESULTS MAP showed a significant intergroup difference over time (Pgroup*time = 0.017); it increased significantly at 5 min after Trendelenburg position in the control group and decreased significantly at 30 min after Trendelenburg position in the magnesium group. The intergroup difference in the change in cortisol concentrations was significant over time (Pgroup*time = 0.006). The cortisol concentration decreased significantly from baseline to 24 h after surgery in the magnesium group but did not change significantly in the control group. The requirement for intraoperative remifentanil was 35% lower in the magnesium group (P = 0.011), and the severity of postoperative pain at 30 min and 6 h after surgery was also lower in the magnesium group (P = 0.024 and P = 0.015). CONCLUSION There is a possibility that intravenous magnesium administration during robotic radical prostatectomy reduces the increases in arterial pressure, cortisol concentrations, opioid requirements, and postoperative pain. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02833038.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Kyeong Jun
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Ji Eun Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea.
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Das JK, Singh M, Rangad G. Combined Retroperitoneal and Transperitoneal Laparoscopic Procedures by a Single Surgeon: Boon to Economically and Medically Backward Areas. Cureus 2021; 13:e13152. [PMID: 33692922 PMCID: PMC7937401 DOI: 10.7759/cureus.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction This study was done to evaluate our experience of combining a retroperitoneal laparoscopic urological operation with other transperitoneal laparoscopic operations. Materials and methods We present a retrospective study of a series of 20 cases of retroperitoneal laparoscopic urological surgeries combined with at least one transperitoneal laparoscopic procedures, performed by a senior minimally invasive surgeon, between March 2013 and August 2020. We have excluded three patients where either of the procedures required conversion to open surgery. We retrospectively reviewed all the data regarding the patient's demographics, combined surgical procedures done, operative time taken, blood loss, intraoperative and postoperative complications, and days of hospital stay. Results Total of 20 patients had undergone simultaneous retroperitoneal and transperitoneal laparoscopic procedures. A total of nine (45%) cases comprised a combination of retroperitoneal laparoscopic ureterolithotomy and laparoscopic cholecystectomy. Two patients had undergone a combination of three laparoscopic procedures in the same operation. The mean hospital stay was 3.6 days. Blood loss was minimal to moderate in all the patients, none needed any perioperative blood transfusion. No major complications were noted in any patients. Conclusion Combining a retroperitoneal laparoscopic urological procedure with another transperitoneal laparoscopic surgery is very much feasible. It becomes even easier and relevant provided both the procedures are performed by a single, experienced laparoscopic surgeon.
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Affiliation(s)
- Jayanta Kumar Das
- Department of General and Minimally Invasive Surgery, Nazareth Hospital, Shillong, IND
| | - Mayank Singh
- Department of General and Minimally Invasive Surgery, Nazareth Hospital, Shillong, IND
| | - Gordon Rangad
- Department of General and Minimally Invasive Surgery, Nazareth Hospital, Shillong, IND
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Cochetti G, Cocca D, Maddonni S, Paladini A, Sarti E, Stivalini D, Mearini E. Combined Robotic Surgery for Double Renal Masses and Prostate Cancer: Myth or Reality? MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E318. [PMID: 32604918 PMCID: PMC7353895 DOI: 10.3390/medicina56060318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022]
Abstract
With the widespread use of imaging modalities performed for the staging of prostate cancer, the incidental detection of synchronous tumors is increasing in frequency. Robotic surgery represents a technical evolution in the treatment of solid tumors of the urinary tract, and it can be a valid option in the case of multi-organ involvement. We reported a case of synchronous prostate cancer and bifocal renal carcinoma in a 66-year-old male. We performed the first case of a combined upper- and lower-tract robotic surgery for a double-left-partial nephrectomy associated with radical prostatectomy by the transperitoneal approach. A comprehensive literature review in this field has also been carried out. Total operative time was 265 min. Renal hypotension time was 25 min. Blood loss was 250 mL. The patient had an uneventful postoperative course. No recurrence occurred after 12 months. In the literature, 10 cases of robotic, radical, or partial nephrectomy and simultaneous radical prostatectomy have been described. Robotic surgery provides less invasiveness than open surgery with comparable oncological efficacy, overcoming the limitations of the traditional laparoscopy. During robotic combined surgery for synchronous tumors, the planning of the trocars' positioning is crucial to obtain good surgical results, reducing the abdominal trauma, the convalescence, and the length of hospitalization with a consequent cost reduction. Rare complications can be related to prolonged pneumoperitoneum. Simultaneous robotic prostatectomy and partial nephrectomy appears to be a safe and feasible surgical option in patients with synchronous prostate cancer and renal cell carcinoma.
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Affiliation(s)
| | - Diego Cocca
- Department of Surgical and Biomedical Sciences, Urology Clinic of Perugia, Perugia University, 06100 Perugia, Italy; (G.C.); (S.M.); (A.P.); (E.S.); (D.S.); (E.M.)
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10
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Çiçek MÇ, Kaynak Y, Günseren KÖ, Kaygısız O, Vuruşkan H. The effects of laparoscopic urologic surgery on cardiac functions: A pulse wave velocity study. Turk J Urol 2020; 46:1-5. [PMID: 32053098 PMCID: PMC6944419 DOI: 10.5152/tud.2020.19094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of laparoscopic urologic surgery on cardiac functions by the parameter pulse wave velocity (PWV), a noninvasive method. MATERIAL AND METHODS Between July 2012 and February 2013, a total of 47 patients were included in this prospective controlled study. Patients who have been scheduled for laparoscopic surgery (LS) (n=30) and open surgery (n=17) were enrolled in the study. Preoperative, perioperative, and postoperative cardiovascular parameters were measured by a PWV instrument, and the results were compared between laparoscopic (L) group and open (C) group. RESULTS In the L group, compared to preoperative values, perioperative systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure increased considerably, by 2.6%, 7.9%, and 4.7%, respectively. This was in contrary to reductions in these parameters by 9.5%, 5.7%, and 10%, respectively, in the C group. For the L group, cardiac output (CO) and cardiac index (CI) were increased in the perioperative period and decreased in the postoperative period. For the C group, there were no changes in measurements of perioperative and postoperative CO and CI. However, these changes in CO and CI were not significantly different between the L and C groups. Postoperative large artery elasticity index decreased in both groups. However, these changes did not represent significant difference between groups. CONCLUSION Compared to open surgery, LS may cause increases in perioperative blood pressures. In addition, increased blood pressures may last even on the first postoperative day. These effects may be more important for patients with high cardiovascular risk.
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Affiliation(s)
| | - Yurdaer Kaynak
- Department of Urology, Eskişehir Ümit Hospital, Eskişehir, Turkey
| | | | - Onur Kaygısız
- Department of Urology, Uludağ University School of Medicine, Bursa, Turkey
| | - Hakan Vuruşkan
- Department of Urology, Uludağ University School of Medicine, Bursa, Turkey
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11
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Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature. Curr Opin Obstet Gynecol 2018; 30:272-278. [DOI: 10.1097/gco.0000000000000471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Cartapatti M, Machado RD, Muller RL, Magnabosco WJ, Santos AC, Chapin BF, Melani A, Talvane A, Tobias-Machado M, Faria EF. Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option? Int Braz J Urol 2018; 44:483-490. [PMID: 29219275 PMCID: PMC5996783 DOI: 10.1590/s1677-5538.ibju.2017.0429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/13/2017] [Indexed: 12/28/2022] Open
Abstract
Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.
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Blecha S, Harth M, Zeman F, Seyfried T, Lubnow M, Burger M, Denzinger S, Pawlik MT. The impact of obesity on pulmonary deterioration in patients undergoing robotic-assisted laparoscopic prostatectomy. J Clin Monit Comput 2018; 33:133-143. [PMID: 29663179 DOI: 10.1007/s10877-018-0142-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/12/2018] [Indexed: 12/23/2022]
Abstract
Obesity affects respiratory and hemodynamic function in anesthetized patients. The aim of this study was to evaluate the influence of the body mass index (BMI) on pulmonary changes in a permanent 45° steep Trendelenburg position (STP) during robotic-assisted laparoscopic prostatectomy (RALP). 51 patients undergoing RALP under standardized anesthesia were included. Perioperative pulmonary function and oxygenation were measured in awake patients (T0), 20 min after the induction of anesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini's plexus in STP (T4), before awakening while supine (T5), and after 45 min in the recovery room (T6). Patient-specific and time-dependent factor on ventilation and predicted peak inspiratory pressure (PIP), driving pressure (Pdriv) and lung compliance (LC) in a linear regression model were calculated. PIP and Pdriv increased significantly after induction of capnoperitoneum (T2-4) (p < 0.0001). In univariate mixed effects models, BMI was found to be a significant predictor for PIP and Pdriv increase and LC decrease. Obese patients a BMI > 31 kg/m2 reached critical PIP values ≥ 35 cmH2O. Postoperative oxygenation represented by the PaO2/FiO2 ratio was significantly decreased compared to T0 (p < 0.0001). Obesity in combination with STP and capnoperitoneum during RALP has a profound effect on pulmonary function. Increased PIP and Pdriv and decreased LC are directly correlated with a high BMI. Changes in PIP, Pdriv and LC during RALP may be predicted in relation to patient's BMI for consideration in the preoperative setting. Trial registration number Z-2014-0387-6. Registered on 8 July 2014.
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Affiliation(s)
- Sebastian Blecha
- Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Marion Harth
- Department of Anesthesiology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Timo Seyfried
- Department of Anesthesiology, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Matthias Lubnow
- Department of Internal Medicine II, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Michael T Pawlik
- Department of Anesthesiology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
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Hur M, Yoo S, Choi JY, Park SK, Jung DE, Kim WH, Kim JT, Bahk JH. Positive end-expiratory pressure-induced increase in external jugular venous pressure does not predict fluid responsiveness in laparoscopic prostatectomy. J Anesth 2018; 32:316-325. [DOI: 10.1007/s00540-018-2475-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 02/22/2018] [Indexed: 01/31/2023]
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Spinelli G, Vargas M, Aprea G, Cortese G, Servillo G. Pediatric anesthesia for minimally invasive surgery in pediatric urology. Transl Pediatr 2016; 5:214-221. [PMID: 27867842 PMCID: PMC5107376 DOI: 10.21037/tp.2016.09.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Laparoscopic or robotic minimally invasive approaches have become the standard of care for many urological pediatric surgical procedures. Anesthetic concerns for conventional and robotic laparoscopy are similar since they both require insufflations of CO2 to allow visualization of surgical field and perform surgery. Even if required insufflation pressures and volumes are lower in pediatric patients (given the small size of the abdomen and laxity of the abdominal walls), the associated increase of intra-abdominal pressure, along with absorption of CO2 and surgical positioning requirement, may result in neurendocrine and mechanical impact capable to mine cardiopulmonary function. Moreover, laparoscopic approach may require specific positioning. A correct positioning is essential to allow the surgical team to optimally and safely access to the patient. The knowledge of patient's health status, along with the multiple physiologic changes that can occur and specific potential complications, allow the anesthesiologist to provide a safer an aesthesia.
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Affiliation(s)
- Gianmario Spinelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianfranco Aprea
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Cortese
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery. J Clin Monit Comput 2016; 31:85-92. [PMID: 26823286 PMCID: PMC5253149 DOI: 10.1007/s10877-016-9831-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022]
Abstract
Robotic assisted surgery (RAS) represents a great challenge for anesthesiology due to the increased intraabdomial pressures required for surgical optimal approach. The changes in lung physiology are difficult to predict and require fast decision making in order to prevent altered gas exchange. The aim of this study was to document the combined effect of patient physical status, medical history and intraoperative position during RAS on lung physiology and to determine perioperative risk factors for hypercapnia. We prospectively analyzed 62 patients who underwent elective RAS. Age, co-morbidities and body mass index (BMI) were recorded before surgery. Ventilatory parameters and arterial blood gas analysis were determined before induction of anesthesia, after tracheal intubation and on an hourly basis until the end of surgery. In RAS, the induction of pneumoperitoneum was associated with a significant decrease in lung compliance from a mean of 42.5–26.7 ml cm H2O−1 (p = 0.001) and an increase in plateau pressure from a mean of 16.1 mmHg to a mean of 23.6 mmHg (p = 0.001). Obesity, demonstrated by a BMI over 30, significantly correlates with a decrease in lung compliance after induction of anesthesia (p = 0.001). A significant higher increase in arterial CO2 tension was registered in patients undergoing RAS in steep Trendelenburg position (p = 0.05), but no significant changes in end-tidal CO2 were recorded. A higher arterial to end-tidal CO2 tension gradient was observed in patients with a BMI > 30 (p < 0.001). In conclusion, patients’ physical status, especially obesity, represents the main risk factor for decreased lung compliance during RAS and patient positioning in either Trendelenburg or steep Trendelenburg during surgery has limited effects on respiratory physiology.
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Seo H, Kong YG, Jin SJ, Chin JH, Kim HY, Lee YK, Hwang JH, Kim YK. Dynamic Arterial Elastance in Predicting Arterial Pressure Increase After Fluid Challenge During Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study. Medicine (Baltimore) 2015; 94:e1794. [PMID: 26469925 PMCID: PMC4616778 DOI: 10.1097/md.0000000000001794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During robot-assisted laparoscopic prostatectomy, specific physiological conditions such as carbon dioxide insufflation and the steep Trendelenburg position can alter the cardiac workload and cerebral hemodynamics. Inadequate arterial blood pressure is associated with hypoperfusion, organ damage, and poor outcomes. Dynamic arterial elastance (Ea) has been proposed to be a useful index of fluid management in hypotensive patients. We therefore evaluated whether dynamic Ea can predict a mean arterial pressure (MAP) increase ≥ 15% after fluid challenge during pneumoperitoneum and the steep Trendelenburg position.We enrolled 39 patients receiving robot-assisted laparoscopic prostatectomy. Fluid challenge was performed with 500 mL colloids in the presence of preload-dependent conditions and arterial hypotension. Patients were classified as arterial pressure responders or arterial pressure nonresponders according to whether they showed an MAP increase ≥15% after fluid challenge. Dynamic Ea was defined as the ratio between the pulse pressure variation and stroke volume variation. Receiver operating characteristic curve analysis was performed to assess the arterial pressure responsiveness after fluid challenge during robot-assisted laparoscopic prostatectomy.Of the 39 patients, 17 were arterial pressure responders and 22 were arterial pressure nonresponders. The mean dynamic Ea before fluid challenge was significantly higher in arterial pressure responders than in arterial pressure nonresponders (0.79 vs 0.61, P < 0.001). In receiver operating characteristic curve analysis, dynamic Ea showed an area under the curve of 0.810. The optimal cut-off value of dynamic Ea for predicting an MAP increase of ≥ 15% after fluid challenge was 0.74.Dynamic Ea can predict an MAP increase ≥ 15% after fluid challenge during robot-assisted laparoscopic prostatectomy. This result suggests that evaluation of arterial pressure responsiveness using dynamic Ea helps to maintain an adequate arterial blood pressure and to improve perioperative outcomes in preload-dependent patients receiving robot-assisted laparoscopic prostatectomy under pneumoperitoneum and in the steep Trendelenburg position.
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Affiliation(s)
- Hyungseok Seo
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea (HS); Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (Y-GK, S-JJ, J-HC, J-HH, Y-KK); and Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea (H-YK, Y-KL)
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Şinikoğlu NS, Gümüş F, Şanlı N, Totoz T, Alagöl A, Turan N. Cardiac and Liver Marker Alterations After Laparoscopic Gynaecologic Operations. Turk J Anaesthesiol Reanim 2015; 43:73-7. [PMID: 27366471 DOI: 10.5152/tjar.2014.83604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 06/04/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In our study, we aimed to investigate the effect of laparoscopic procedures in which the abdominal cavity at a Trendelenburg position of 15 degrees was insufflated with CO2 on cardiac and liver markers. METHODS Forty patients scheduled for laparoscopic gynaecological surgery were included in the study. Venous blood samples were taken the day before operation and 6 hours after surgery, and later, lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase-MB (CK-MB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), myoglobin (MY) and d-dimer (d-D) were measured. RESULTS There was no statistically significant difference in the values of preoperative and postoperative ALT (16.8±9.4 and 17.8±9.3; p=0.579), AST (19.4±7 and 20.9±7.6; p=0.361) and ALP (65.2±16.2 and 63.3±16.9; p=0.609), but LDH (385.1±117.3 and 460.6±156.3; p=0.003), CK (113.8±138.5 and 247.9±283.5; p=0.0001), CK-MB (22.8±13.3 and 28.7±16; p=0.011), MY (28.1±12.9 and 138.8±129; p=0.0001) and d-D (509.5±815: 1026±1054; p=0.0001) increased significantly. CONCLUSION After laparoscopic operations in the Trendelenburg position, postoperative serum ALT, AST and ALP levels, remained unchanged, when compared to preoperative values, but LDH, CK, CK-MB, myoglobin and d-dimer values increased significantly.
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Affiliation(s)
- Nadir Sıtkı Şinikoğlu
- Clinic of Anaesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Funda Gümüş
- Clinic of Anaesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Nalan Şanlı
- Clinic of Anaesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Tolga Totoz
- Clinic of Anaesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Ayşin Alagöl
- Clinic of Anaesthesiology and Reanimation, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Nesrin Turan
- Department of Biostatistics, Trakya University Faculty of Medicine, Edirne, Turkey
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Kilic O, Börgers A, Köhne W, Musch M, Kröpfl D, Groeben H. Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease. Br J Anaesth 2015; 114:70-6. [DOI: 10.1093/bja/aeu322] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rosendal C, Markin S, Hien MD, Motsch J, Roggenbach J. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth 2014; 26:383-9. [PMID: 25086483 DOI: 10.1016/j.jclinane.2014.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 01/01/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To determine and interpret the changes in preload, afterload, and cardiac function in the different phases of robot-assisted laparoscopic prostatectomy. DESIGN Prospective, observational monocenter study. SETTING Operating room at a university hospital. PATIENTS 31 consecutive, ASA physical status 1, 2, and 3 patients. INTERVENTIONS Observations were made at 5 distinct time points: baseline after induction of anesthesia, after initiation of capnoperitoneum, immediately after a 45° head-down tilt, 15 minutes after the 45° head-down tilt was established, after the release of the capnoperitoneum, and 5 minutes after the patient was returned to a horizontal position (end). MEASUREMENTS Transpulmonary thermodilution and pulse contour analysis were used to record hemodynamic changes in preload, afterload, and cardiac function. MAIN RESULTS While central venous pressure increased threefold from baseline, none of the other preload parameters showed excessive fluid overload or demand. There was no significant change in cardiac contractility over time. Afterload increased significantly during the capnoperitoneum and significantly decreased compared with baseline after the release of abdominal pressure at the end of the procedure. Heart rate and cardiac index increased significantly during robot-assisted laparoscopic prostatectomy. CONCLUSIONS Selective arterial vasodilation at the time of capnoperitoneum may normalize afterload and myocardial oxygen demand.
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Affiliation(s)
- Christian Rosendal
- Hirslanden Clinics Berne, Klinik Beau-Site, Schänzlihalde 11, 3000 Bern 25, Switzerland; Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany.
| | - Sergei Markin
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - Maximilian D Hien
- Research Training Group 1126, University of Heidelberg, German Research Foundation (DFG), INF 110, 69120 Heidelberg, Germany; Department of Pediatrics, University of Heidelberg, INF 430, 69120 Heidelberg, Germany
| | - Johann Motsch
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - Jens Roggenbach
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
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The Impact of a Pelvic Pillow on Learning How to Perform Laparoscopic Low Anterior Resection for Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2014; 24:259-63. [DOI: 10.1097/sle.0b013e31828fa659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oksar M, Akbulut Z, Ocal H, Balbay MD, Kanbak O. Considerações anestésicas para cistectomia robótica: estudo prospectivo. Braz J Anesthesiol 2014. [DOI: 10.1016/j.bjan.2013.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Jung JH, Kim HW, Oh CK, Song JM, Chung BH, Hong SJ, Rha KH. Simultaneous robot-assisted laparoendoscopic single-site partial nephrectomy and standard radical prostatectomy. Yonsei Med J 2014; 55:535-8. [PMID: 24532529 PMCID: PMC3936649 DOI: 10.3349/ymj.2014.55.2.535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022] Open
Abstract
Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot- assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Oksar M, Akbulut Z, Ocal H, Balbay MD, Kanbak O. Anesthetic considerations for robotic cystectomy: a prospective study. Braz J Anesthesiol 2013; 64:109-15. [PMID: 24794453 DOI: 10.1016/j.bjane.2013.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/02/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients. PATIENTS Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg+pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. RESULTS There were significant differences between T0-T1 and T0-T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean f values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0. CONCLUSIONS Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created.
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Affiliation(s)
- Menekse Oksar
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
| | - Ziya Akbulut
- Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Hakan Ocal
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Orhan Kanbak
- Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
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Parikh BK, Shah VR, Modi PR, Butala BP, Parikh GP. Anaesthesia for laparoscopic kidney transplantation: Influence of Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, respiratory and renal function. Indian J Anaesth 2013; 57:253-8. [PMID: 23983283 PMCID: PMC3748679 DOI: 10.4103/0019-5049.115607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Laparoscopic donor nephrectomy is a routine practice since 1995. Until now, the recipient has always undergone open surgery for transplantation. In our institute, laparoscopic kidney transplantation (LKT) started in 2010. To facilitate this surgery, the patient must be in steep Trendelenburg position for a long duration. Hence, we decided to study the effect of CO2 pnuemoperitoneum and Trendelenburg position in chronic renal failure (CRF) patients undergoing LKT. Methods: A total of 20 adult CRF patients having mean age of 31.7±10.36 years and body mass index 19.65±3.41 kg/m2 without significant coronary artery disease were selected for the procedure. Cardiovascular parameters heart rate (HR), mean arterial pressure (MAP), Central venous pressure (CVP) and respiratory parameters (ETCO2, peak airway pressure) were noted at the time of induction, after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position, 15 min after decompression of pnuemoperitonuem and after extubation. Arterial blood gas analysis was carried out after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position and 15 min after clamp release. Total duration of surgery, anastomosis time, time for the establishment of urine output and total urine output were noted. Serum creatinine on the 1st and 7th post-operative day were recorded. Results: Significant increase in HR was observed after creation of CO2 pneumoperitoneum and just before extubation. Significant increase in the MAP and CVP was noted after creation of pneumoperitoneum and after giving Trendelenburg position. No significant rise in the ETCO2 and PaCO2 was observed. Significant increase in the base deficit was observed after the clamp release, but none of the patients required correction. Conclusion: LKT performed in steep Trendelenburg position with CO2 pneumoperitoneum significantly influenced cardiovascular and respiratory homeostasis; however, measured parameters remained within clinically acceptable range without affecting early function of the transplanted kidney.
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Affiliation(s)
- Beena Kandarp Parikh
- Department of Anaesthesia and Critical Care, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat, India
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Kadono Y, Yaegashi H, Machioka K, Ueno S, Miwa S, Maeda Y, Miyagi T, Mizokami A, Fujii Y, Tsubokawa T, Yamamoto K, Namiki M. Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy. Int J Med Robot 2013; 9:17-22. [PMID: 23348954 DOI: 10.1002/rcs.1482] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis. METHODS Forty-seven ASA physical status 1 and 2 patients underwent open retropubic radical prostatectomy (RRP) or RALP. Patients receiving RALP were randomized to undergo the operation in the 20°, 25° or 30° Trendelenburg position. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2 ), tidal volume (Vt), peak inspiratory pressure (PIP) and dynamic compliance (Cdyn) were recorded during the operation. RESULTS Angle of head-down tilt was significantly correlated with MAP, PIP and Cdyn, but not with HR, RR or PetCO2 . MAP decreased gradually over time in each group in the Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt became stronger, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease. CONCLUSIONS This study demonstrated that the degree of the head-down angle at RALP affected the cardiovascular and respiratory parameters. Pneumoperitoneum with head-down position in RALP influenced the cardiovascular and respiratory system to a greater extent than RRP, and these effects were stronger with deeper head-down angle.
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Affiliation(s)
- Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Japan.
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Choi DK, Lee IG, Hwang JH. Arterial to end-tidal carbon dioxide pressure gradient increases with age in the steep Trendelenburg position with pneumoperitoneum. Korean J Anesthesiol 2012; 63:209-15. [PMID: 23060976 PMCID: PMC3460148 DOI: 10.4097/kjae.2012.63.3.209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/26/2012] [Accepted: 04/12/2012] [Indexed: 11/10/2022] Open
Abstract
Background Several factors affect the end-tidal carbon dioxide pressure (PETCO2) and increase the arterial to end-tidal carbon dioxide pressure gradient (Pa-ETCO2) during general anesthesia. We evaluated the relationship between age and Pa-ETCO2 during pneumoperitoneum in the steep Trendelenburg position in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). Methods Ninety-two consecutive patients undergoing RALP were divided by age into a middle-aged (45-65 years) and an elderly (> 65 years) group. Anesthesia was standardized. Heart rate, mean arterial pressure, peak inspiratory pressure, lung compliance, minute ventilation, PaO2, PETCO2, PaCO2, and Pa-ETCO2 were measured 10 min after intubation in the supine position without pneumoperitoneum (T0); and 10 (T1), 60 (T2), and 120 (T3) min after pneumoperitoneum in the Trendelenburg position. Results Although PETCO2 did not change significantly during surgery, PaCO2 and Pa-ETCO2 increased gradually with time during pneumoperitoneum in the Trendelenburg position, and both parameters showed greater increases in the elderly than in the middle-aged group. Simple linear regression analyses revealed significant correlations between age and Pa-ETCO2 at T0 (P = 0.018), T1 (P = 0.006), T2 (P < 0.001), and T3 (P = 0.001). Linear mixed model analysis showed that Pa-ETCO2 was associated statistically significantly with age and duration of pneumoperitoneum in the Trendelenburg position, but age and duration of pneumoperitoneum in the Trendelenburg position were not associated (P = 0.090). Conclusions The magnitude of Pa-ETCO2 during pneumoperitoneum in the steep Trendelenburg position increased with age, which could be attributed to age-related respiratory physiological changes.
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Affiliation(s)
- Dae-Kee Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Anesthetic considerations for robotic prostatectomy: a review of the literature. J Clin Anesth 2012; 24:494-504. [DOI: 10.1016/j.jclinane.2012.03.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 03/20/2012] [Accepted: 03/30/2012] [Indexed: 12/22/2022]
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Darlong V, Kunhabdulla NP, Pandey R, Chandralekha, Punj J, Garg R, Kumar R. Hemodynamic changes during robotic radical prostatectomy. Saudi J Anaesth 2012; 6:213-8. [PMID: 23162392 PMCID: PMC3498657 DOI: 10.4103/1658-354x.101210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Effect on hemodynamic changes and experience of robot-assisted laparoscopic radical prostatectomy (RALRP) in steep Trendelenburg position (45°) with high-pressure CO(2) pneumoperitoneum is very limited. Therefore, we planned this prospective clinical trial to study the effect of steep Tredelenburg position with high-pressure CO(2) pneumoperitoneum on hemodynamic parameters in a patient undergoing RALRP using FloTrac/Vigileo™1.10. METHODS After ethical approval and informed consent, 15 patients scheduled for RALRP were included in the study. In the operation room, after attaching standard monitors, the radial artery was cannulated. Anesthesia was induced with fentanyl (2 μg/kg) and thiopentone (4-7 mg/kg), and tracheal intubation was facilitated by vecuronium bromide (0.1 mg/kg). The patient's right internal jugular vein was cannulated and the Pre Sep™ central venous oximetry catheter was connected to it. Anesthesia was maintained with isoflurane in oxygen and nitrous oxide and intermittent boluses of vecuronium. Intermittent positive-pressure ventilation was provided to maintain normocapnea. After CO(2) pneumoperitoneum, position of the patient was gradually changed to 45° Trendelenburg over 5 min. The robot was then docked and the robot-assisted surgery started. Intraoperative monitoring included central venous pressure (CVP), stroke volume (SV), stroke volume variation (SVV), cardiac output (CO), cardiac index (CI) and central venous oxygen saturation (ScvO(2)). RESULTS After induction of anesthesia, heart rate (HR), SV, CO and CI were decreased significantly from the baseline value (P>0.05). SV, CO and CI further decreased significantly after creating pneumoperitoneum (P>0.05). At the 45° Trendelenburg position, HR, SV, CO and CI were significantly decreased compared with baseline. Thereafter, CO and CI were persistently low throughout the 45° Trendelenburg position (P=0.001). HR at 20 min and 1 h, SV and mean arterial blood pressure after 2 h decreased significantly from the baseline value (P>0.05) during the 45° Trendelenburg position. CVP increased significantly after creating pneumoperitoneum and at the 45° Trendelenburg position (after 5 and 20 min) compared with the baseline postinduction value (P>0.05). All these parameters returned to baseline after deflation of CO(2) pneumoperitoneum in the supine position. There were no significant changes in SVV and ScvO(2) throughout the study period. CONCLUSIONS The steep Trendelenburg position and CO(2) pneumoperitoneum, during RALRP, leads to significant decrease in stroke volume and cardiac output.
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Affiliation(s)
- Vanlal Darlong
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
- Address for correspondence: Prof. Vanlal Darlong, Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India. E-mail:
| | | | - Ravindra Pandey
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Chandralekha
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Jyotsna Punj
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Garg
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajeev Kumar
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Levy BF, Fawcett WJ, Scott MJP, Rockall TA. Intra-operative oxygen delivery in infusion volume-optimized patients undergoing laparoscopic colorectal surgery within an enhanced recovery programme: the effect of different analgesic modalities. Colorectal Dis 2012; 14:887-92. [PMID: 21895923 DOI: 10.1111/j.1463-1318.2011.02805.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Patients undergoing major open surgery who have an indexed oxygen delivery (DO(2) I) > 600 ml/min/m(2) have been shown to have a lower incidence of morbidity and mortality compared with those whose DO(2) I is below this level. Laparoscopy and Trendelenburg positioning cause a reduction in DO(2) I. We aimed to quantify the effect of the type of analgesia on DO(2) I and to correlate the DO(2) I achieved with the incidence of anastomotic leakage in patients undergoing laparoscopic surgery. METHOD Following ethical approval, patients were randomized to receive spinal anaesthesia (Group S), epidural analgesia (Group E) or intravenous morphine (Group P) followed by postoperative patient-controlled analgesia (PCA). In addition to standard monitoring, oesophageal Doppler monitoring of the stroke volume allowed directed intravenous fluid therapy. The mean DO(2) I was compared with the anastomotic leakage rate. RESULTS Seventy-five patients were recruited (Group S, 27; Group E, 23; Group P, 25). The mean (range) DO(2) I for all patients was 490 (230-750) ml/min/m(2) . The analgesic modality had no effect on DO(2) I. Of the 18 patients with a DO(2) I of < 400 ml/min/m(2) , four (22%) developed anastomotic leakage compared with one (%) of the 57 patients with a DO(2) I of > 400 ml/min/m(2) (P = 0.01). CONCLUSION The analgesic modality used had no effect on the DO(2) I achieved. Anastomotic leakage was significantly higher in patients with a DO(2) I of < 400 ml/min/m(2) . A further study assessing the outcome after raising the DO(2) I with inotropes is required.
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Affiliation(s)
- B F Levy
- Department of Surgery, Institution: Minimal Access Therapy Training Unit, Post Graduate Medical School, University of Surrey, Manor Park, Guildford, Surrey, UK.
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Beckmann J, Bein B, Steinfath M, Becker T. [Intraoperative surgical and anesthesiological problems and the consequences for surgery]. Chirurg 2012; 83:617-25. [PMID: 22692374 DOI: 10.1007/s00104-011-2213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although the procedures for severe intraoperative complications have largely been defined, in everyday life less dramatic but equally important problems and issues arise which are controversially debated between treating surgeons and the anesthesiologists. Preoperative anemia, transfusion therapy, fluid management, patient positioning, hypothermia and neuromuscular blockade are the focus of the occasionally conflicting interests of anesthesiologists and surgeons. Good reciprocal communication and mutual understanding are a requirement for proactive management of complications. The overall objective is the reduction of intraoperative risks thereby reducing morbidity and mortality. This can be achieved through modern fluid management, blood conserving techniques and maintenance of normothermia. Surgeons further require an optimal view during minimally invasive surgery even by complex patient positioning and adequate neuromuscular blockade.
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Affiliation(s)
- J Beckmann
- Klinik für Allgemeine Chirurgie und Thoraxchirurgie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Arnold Heller Str. 3, 24105, Kiel, Deutschland.
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Jung JH, Arkoncel FRP, Lee JW, Oh CK, Yusoff NAM, Kim KJ, Rha KH. Initial clinical experience of simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. Yonsei Med J 2012; 53:236-9. [PMID: 22187260 PMCID: PMC3250319 DOI: 10.3349/ymj.2012.53.1.236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/03/2010] [Accepted: 11/09/2010] [Indexed: 12/19/2022] Open
Abstract
A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | - Jae Won Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | | | - Kwang Jin Kim
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
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Mizrahi H, Hugkulstone CE, Vyakarnam P, Parker MC. Bilateral ischaemic optic neuropathy following laparoscopic proctocolectomy: a case report. Ann R Coll Surg Engl 2011; 93:e53-4. [PMID: 21943450 DOI: 10.1308/147870811x582828] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Perioperative visual loss occurring during non-ocular surgery is a devastating event. Ischaemic optic neuropathy (ION) is a complication described following many procedures. We report the first case of ION occurring during laparoscopic proctocolectomy and discuss the aetiological factors. CASE HISTORY A 58-year-old male presented with rectal bleeding and was diagnosed with an adenocarcinoma of the sigmoid colon. A very difficult laparoscopic sigmoidectomy and a low anterior resection of the rectum with an end colostomy were carried out. The technical difficulties were due to body habitus and the size and position of the tumour. The operation lasted over six hours. On the first day postoperatively, the patient complained of blurred vision. Examination showed that he had suffered bilateral ION. DISCUSSION Despite the growing numbers of laparoscopic operations, ION has rarely been described. The cases that were published involved laparoscopic prostatectomy and a prolonged steep Trendelenburg position. We postulate that the patient presented here had suffered both from a relative hypotension and from an acute rise in the intraorbital pressure due to patient position, both factors combining to cause a disruption to ocular perfusion resulting in ION with severe permanent visual damage.
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Affiliation(s)
- H Mizrahi
- Department of Colorectal Surgery, Darent Valley Hospital, Dartford, UK.
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Goldstraw MA, Challacombe BJ, Patil K, Amoroso P, Dasgupta P, Kirby RS. Overcoming the challenges of robot-assisted radical prostatectomy. Prostate Cancer Prostatic Dis 2011; 15:1-7. [PMID: 21844888 DOI: 10.1038/pcan.2011.37] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Robot-assisted radical prostatectomy (RARP) is the most commonly performed robotic procedure worldwide and is firmly established as a standard treatment option for localised prostate cancer. Part of the explanation for the rapid uptake of RARP is the reported gentler learning curve compared with the challenges of laparoscopic radical prostatectomy (LRP). However, robotic surgery is still fraught with potential difficulties and avoiding complications while on the steepest part of the learning curve is critical. Furthermore, as surgeons progress there is a tendency to take on increasingly complex cases, including patients with difficult anatomy and prior surgery, and these cases present a unique challenge. Significant intra-abdominal adhesions may be identified following open surgery, or dense periprostatic inflammation may be encountered following TURP; large prostate gland size and median lobes may alter bladder neck anatomy, making difficult subsequent urethro-vesical anastomosis. Even experienced robotic surgeons will be challenged by salvage RARP. Approaching these problems in a structured manner allows many of the problems to be overcome. We discuss some of the specific techniques to deal with these potential difficulties and highlight ways to avoid making serious mistakes.
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Affiliation(s)
- M A Goldstraw
- Barnet and Chase Farm NHS Trust, Enfield, London, UK.
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Kim SH, Park SY, Cui J, Lee JH, Cho SH, Chae WS, Jin HC, Hwang KH. Peripheral venous pressure as an alternative to central venous pressure in patients undergoing laparoscopic colorectal surgery. Br J Anaesth 2011; 106:305-11. [PMID: 21258073 DOI: 10.1093/bja/aeq399] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peripheral venous pressure (PVP) is strongly correlated with central venous pressure (CVP) during various surgeries. Laparoscopic surgery in the Trendelenburg position with pneumoperitoneum typically increases CVP. To determine whether PVP convincingly reflects changes in CVP, we evaluated the correlation between PVP and CVP in patients undergoing laparoscopic colorectal surgery. METHODS Both CVP and PVP were measured simultaneously at predetermined time intervals during elective laparoscopic colorectal surgery in 42 patients without cardiac disease. The pairs of venous pressure measurements were analysed for correlation, and the Bland-Altman plots of repeated measures were used to evaluate the agreement between CVP and PVP. RESULTS A total of 420 data pairs were obtained. The overall mean CVP was 11.3 (sd 4.5) mm Hg, which was significantly lower than the measured PVP of mean 12.1 (4.5) mm Hg (P=0.005). There was a strong positive correlation between overall CVP and PVP (correlation coefficient=0.96, P<0.0001). The mean bias (PVP-CVP) corrected for repeated measurements using random-effects modelling was 0.9 mm Hg [95% confidence interval (CI) 0.54-1.19 mm Hg] with 95% limits of agreement of -1.2 mm Hg (95% CI -1.75 to -0.62 mm Hg) to 2.9 mm Hg (95% CI 2.35-3.48 mm Hg). CONCLUSIONS PVP displays a strong correlation and agreement with CVP under the increased intrathoracic pressure of pneumoperitoneum in the Trendelenburg position and may be used as an alternative to CVP in patients without cardiac disease undergoing laparoscopic colorectal surgery.
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Affiliation(s)
- S H Kim
- Department of Anaesthesiology and Pain Medicine, Soonchunhyang University Hospital, College of Medicine, Soonchunhyang University, Bucheon Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, Republic of Korea.
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Lestar M, Gunnarsson L, Lagerstrand L, Wiklund P, Odeberg-Wernerman S. Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position. Anesth Analg 2011; 113:1069-75. [PMID: 21233502 DOI: 10.1213/ane.0b013e3182075d1f] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic radical prostatectomy has gained widespread use. However, circulatory effects in patients subjected to an extreme Trendelenburg position (45°) are not well characterized. METHODS We studied 16 patients (ASA physical status I-II) with a mean age of 59 years scheduled for robot-assisted laparoscopic radical prostatectomy (45° head-down tilt, with an intraabdominal pressure of 11-12 mm Hg). Hemodynamics, echocardiography, gas exchange, and ventilation-perfusion distribution were investigated before and during pneumoperitoneum, in the Trendelenburg position and, in 8 of the patients, also after the conclusion of surgery. RESULTS In the 45° Trendelenburg position, central venous pressure increased almost 3-fold compared with the initial value, with an associated 2-fold increase in mean pulmonary artery pressure and pulmonary capillary wedge pressure (P<0.01). Mean arterial blood pressure increased by 35%. Heart rate, stroke volume, cardiac output, and mixed venous oxygen saturation were unaffected during surgery, as were echocardiographic heart dimensions. After induction of anesthesia, isovolumic relaxation time was prolonged, with no further change during the study. Deceleration time was normal and stable. In the horizontal position after pneumoperitoneum exsufflation, filling pressures and mean arterial blood pressure returned to baseline levels. Pneumoperitoneum reduced lung compliance by 40% (P<0.01). Addition of the Trendelenburg position caused a further decrease (P<0.05). Arterial blood acid-base balance was normal. End-tidal carbon dioxide tension increased whereas arterial carbon dioxide was unaffected with unchanged ventilation settings. Pneumoperitoneum increased PaO2 (P<0.05). Ventilation-perfusion distribution, shunt, and dead space were unaltered during the study. CONCLUSIONS Pneumoperitoneum and 45° Trendelenburg position caused 2- to 3-fold increases in filling pressures, without effects on cardiac performance. Filling pressures were normalized immediately after surgery. Lung compliance was halved. Gas exchange was unaffected. No perioperative cardiovascular complications occurred.
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Affiliation(s)
- Melinda Lestar
- Department of Anesthesiology and Intensive Care, Karolinska University Hospital, S-141 86 Stockholm, Sweden
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Kim EJ, Yoon H. [The effects of pneumoperitoneum on heart rate, mean arterial blood pressure and cardiac output of hypertensive patients during laparoscopic colectomy]. J Korean Acad Nurs 2010; 40:433-41. [PMID: 20634634 DOI: 10.4040/jkan.2010.40.3.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was performed to identify effects of pneumoperitoneum on hemodynamic changes of hypertensive patients undergoing laparoscopic colectomy under general anesthesia. METHODS Data collection was done from January 2 to June 10, 2008. Seventy-six patients, including 38 hypertensive patients, who had taken antihypertensive drugs more than 1 month and 38 normotensive patients undergoing laparoscopic colectomy were enrolled in this study. The hemodynamic parameters were heart rate (HR), mean arterial pressure (MAP) and cardiac output (CO) which were measured 7 times from before induction of anesthesia to 5 min after deflation of the pneumoperitoneum. Collected data were analyzed using Repeated Measures ANOVA and Bonferroni comparison method. RESULTS HR in the hypertensive group was significantly decreased at deflation of the pneumoperitoneum and 5 min after deflation of the pneumoperitoneum (p=.012). MAP in the hypertensive group was not different from the normotensive group (p=.756). CO in hypertensive group was significantly lower than normotensive group (p<.001) from immediately after pneumoperitoneum to 5 min after deflation of the pneumoperitoneum. CONCLUSION The results indicate that pneumoperitoneum during laparoscopic surgery does not lead to clinically negative hemodynamic changes in heart rate, mean arterial pressure or cardiac output of hypertensive patients, who have taken antihypertensive drugs for more than 1 month.
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Affiliation(s)
- Eun Ju Kim
- Department of Nursing, National Cancer Center, Ilsan, Korea
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Impact of the patient's body position on the intraabdominal workspace during laparoscopic surgery. Surg Endosc 2010; 24:1398-402. [PMID: 20054583 PMCID: PMC2869437 DOI: 10.1007/s00464-009-0785-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 11/18/2009] [Indexed: 01/09/2023]
Abstract
Background The effects of the patient’s body position on the intraabdominal workspace in laparoscopic surgery were analyzed. Methods The inflated volume of carbon dioxide was measured after insufflation to a preset pressure of 15 mmHg for 20 patients with a body mass index (BMI) greater than 35 kg/m2. The patients were anesthetized with full muscle relaxation. The five positions were (1) table horizontal with the legs flat (supine position), (2) table in 20° reverse Trendelenburg with the legs flat, (3) table in 20° reverse Trendelenburg with the legs flexed 45° upward at the hips (beach chair position), (4) table horizontal with the legs flexed 45° upward at the hips, and (5) table in 20° Trendelenburg with the legs flat. The positions were performed in a random order, and the first position was repeated after the last measurement. Repeated measure analysis of variance was used to compare inflated volumes among the five positions. Results A significant difference in inflated volume was found between the five body positions (P = 0.042). Compared with the mean inflated volume for the supine position (3.22 ± 0.78 l), the mean inflated volume increased by 900 ml for the Trendelenburg position or when the legs were flexed at the hips, and decreased by 230 ml for the reverse Trendelenburg position. Conclusions The Trendelenburg position for lower abdominal surgery and reverse Trendelenburg with flexing of the legs at the hips for upper abdominal surgery effectively improved the workspace in obese patients, even with full muscle relaxation.
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Hong SH, Choi JH, Lee J. The changes of central venous pressure by body posture and positive end-expiratory pressure. Korean J Anesthesiol 2009; 57:723-728. [PMID: 30625956 DOI: 10.4097/kjae.2009.57.6.723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Central venous pressure (CVP) monitoring provides a useful estimate of the volume status of the systemic circulation. Both increase in the intrathoracic pressure by applying positive-end expiratory pressure (PEEP) and various patient positioning may commonly mislead the interpretation of CVP. We investigated the effect of body posture and different PEEPs on CVP in anesthetized patients. METHODS Ninety-one patients (ASA I or II) scheduled for elective surgery with supine (50 patients), lateral decubitus (27 patients), or prone position (14 patients) were included. After induction of general anesthesia, CVP, mean arterial pressure (MAP), heart rate (HR), end-tidal CO2 (EtCO2) and peak inspiratory pressure (PIP) were measured under different PEEP conditions of 0, 5, 10, and 15 cmH2O in each body posture. RESULTS CVP and PIP increased gradually by the increment of PEEP in patients with all positions. The magnitude of changes of CVP and PIP was significantly greater than other PEEP conditions when PEEP was 15 cmH2O, especially in prone position (P < 0.05). There were no differences in MAP, HR and EtCO2 during the increase of PEEP in all positions. CONCLUSIONS These results suggest that PEEP as much as 15 cmH2O may alter reliability of CVP in estimating adequate circulatory volumes, especially in prone position.
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Affiliation(s)
- Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
| | - Jung Hyun Choi
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
| | - Jaemin Lee
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
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Metzelder ML, Kuebler JF, Huber D, Vieten G, Suempelmann R, Ure BM, Osthaus WA. Cardiovascular responses to prolonged carbon dioxide pneumoperitoneum in neonatal versus adolescent pigs. Surg Endosc 2009; 24:670-4. [DOI: 10.1007/s00464-009-0654-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/25/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, Roth S, Patel V. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg 2009; 109:473-8. [PMID: 19608821 DOI: 10.1213/ane.0b013e3181a9098f] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraocular pressure (IOP) increases in steep Trendelenburg positioning, but the magnitude of the increase has not been quantified. In addition, the factors contributing to this increase have not been studied in robot-assisted prostatectomy cases. In this study, we sought to quantify the changes in IOP and examine perioperative factors responsible for these changes while patients are in the steep Trendelenburg position during robotic prostatectomy. METHODS In this prospective study, we measured IOP using a Tono-pen XL in 33 patients undergoing robot-assisted prostatectomy. The IOP was measured before anesthesia while supine and awake (baseline T1), anesthetized and supine (T2), anesthetized after insufflation of the abdomen with carbon dioxide (CO(2)) (T3), anesthetized in steep Trendelenburg (T4), anesthetized in steep Trendelenburg at the end of the procedure (T5), anesthetized supine before awakening (T6), and 1 hr after awakening in the supine position (T7). RESULTS On average, IOP was 13.3 +/- 0.58 (mean +/- SE) mm Hg higher at the end of the period of steep Trendelenburg position (T5) compared with supine position T1 (P < 0.0001). The least square estimates for each time point in mm Hg were as follows: T1 = 15.7, T2 = 10.7, T3 = 14.6, T4 = 25.2, T5 = 29.0, T6 = 22.2, T7 = 17.0. Using univariate mixed effects models for the T1-T5 time periods, peak airway pressure, mean arterial blood pressure, ETco(2), and time were significant predictors of the IOP increase, whereas age, body mass index, blood loss, volume of IV fluid administered, mean airway pressure, and desflurane concentration were not predictive. In T4-T5, which involved no significant positional or perioperative interventions, we performed a multivariate analysis to evaluate predictors of IOP increases. Surgical duration (in minutes) and ETco(2) were the only significant variables predicting changes in IOP during stable and prolonged Trendelenburg positioning. On average, IOP increased 0.21 mm Hg per mm Hg increase in ETco(2) after adjusting for time. An increase of 0.05 mm Hg in IOP per minute of surgery on average was observed during this period in the Trendelenburg position after adjusting for ETco(2). CONCLUSIONS IOP reached peak levels at the end of steep Trendelenburg position (T5), on average 13 mm Hg higher than the preanesthesia induction (T1) value. Surgical duration and ETco(2) were the only significant predictors of IOP increase in the Trendelenburg position (T4-T5).
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Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Sekimoto M, Nishikawa A, Taniguchi K, Takiguchi S, Miyazaki F, Doki Y, Mori M. Development of a compact laparoscope manipulator (P-arm). Surg Endosc 2009; 23:2596-604. [PMID: 19357921 DOI: 10.1007/s00464-009-0460-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 03/08/2009] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscope manipulating robots are useful for maintaining a stable view during a laparoscopic operation and as a substitute for the surgeon who controls the laparoscope. However, there are several problems to be solved. A large apparatus sometimes interferes with the surgeon. The setting and repositioning is awkward. Furthermore, the initial and maintenance costs are expensive. This study was designed to develop a new laparoscope manipulating robot to overcome those problems. METHODS We developed a compact robot applicable for various types of laparoscopic surgery with less expensive materials. The robot was evaluated by performing an in vitro laparoscopic cholecystectomy using extracted swine organs. Then, the availability of the robot to various operations was validated by performing a laparoscopic cholecystectomy, anterior resection of the rectum, and distal gastrectomy using a living swine. The reliability of the system was tested by long-time continuous running. RESULTS A compact and lightweight laparoscope manipulating robot by the name of P-arm was developed. The surgical time of an in vitro laparoscopic cholecystectomy with and without the P-arm was not different. The three types of operations were accomplished successfully. During the entire procedure, the P-arm worked without trouble and did not interfere with the surgeons. Continuous 8-h operating tests were performed three times and neither discontinuance nor trouble occurred with the system. CONCLUSIONS The P-arm worked steadily for various swine operations, without interfering with surgeon's work.
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Affiliation(s)
- Mitsugu Sekimoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
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Meininger D, Byhahn C. [Special features of laparoscopic operations from an anesthesiologic viewpoint: a review]. Anaesthesist 2008; 57:760-6. [PMID: 18663418 DOI: 10.1007/s00101-008-1422-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The value of laparoscopic procedures has increased over the last decade. Many patients undergoing laparoscopic surgery also have coexisting diseases. The hemodynamic effects of intraperitoneal carbon dioxide insufflation depend on the extent of intraperitoneal pressure, severity of preexisting cardiopulmonary diseases, volume state of the patient and alterations of acid-base balance due to a capnoperitoneum. In addition to endocrinologic reactions, patient positioning also affects hemodynamic parameters. In high risk patients extended cardiopulmonary monitoring with an arterial line and repeated blood gas analysis is recommended intraoperatively, in addition to assessment of end-expiratory CO(2). In this patient group the intra-abdominal pressure should be maintained in the range of 5-7 mmHg.
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Affiliation(s)
- D Meininger
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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