BACKGROUND Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors. METHODS The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products. RESULTS The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II.
Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors. CONCLUSIONS Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.
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Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review Ildar I. Lutfarakhmanov, I. A. Melnikova, E. Yu. Syrchin, V. F. Asadullin, Yu. A. Korelov, P. I. Mironov Annals of Critical Care.2021; (1): 75. CrossRef
BACKGROUND Peritoneal CO2 insufflation results in elevation of PaCO2 and decreased respiratory compliance. Respiratory mechanics can be measured with flow interrupter technique.
This study was designed to evaluate the effect of increased intra-abdominal pressure and positions on respiratory mechanics during laparoscopic surgery. METHODS Female patients undergoing cholecystectomy (10 degrees head-up group, n=9) and gynecologic operation (10 degrees head-down group, n=9) under laparoscopy were studied. The upper limit of intra-abdonimal pressure was set to 12 mmHg. We measured airway flow and airway pressure of patients at preoperation, during insufflation, during positioning, and postoperation. Respiratory data were obtained from D-lite(R)sensor on-line. RESULTS After increased intra-abdominal pressure and positioning, dynamic compliances in both groups were significantly decreased by 31~35%, static compliances by 39~43%. There was no difference of compliance between positions. The elastic tissue resistance of head-up group was significantly elevated compared with after operation.
After operation, the respiratory parameters returned nearly to control levels. CONCLUSIONS This result suggests that the respiratory mechanics should be monitored under laparoscopy continuously. Further studies on clinical condition such as ascites, hemorrhage, and pregnancy were needed.