Ulus Travma Acil Cerrahi Derg. 2024; 30(6): 430-436 | DOI: 10.14744/tjtes.2024.78617

Robotik radikal prostatektomide 8 mmHg ve 12 mmHg pnömoperiton basýnçlarýnýn karþýlaþtýrýlmasý: Anesteziolojik ve cerrahi perspektiften prospektif randomize kontrollü çalýþma

Mete Manici¹, Ýbrahim Can Aykanat², Doga Simsek¹, Kayhan Tarim³, Yavuz Gurkan¹, Abdullah Erdem Canda^3
1Koç Üniversitesi Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýstanbul, Türkiye
²Koç Üniversitesi Hastanesi, Üroloji Kliniði, Ýstanbul, Türkiye
³Koç Üniversitesi Týp Fakültesi, Üroloji Anabilim Dalý, Ýstanbul, Türkiye

AMAÇ: Robot destekli laparoskopik radikal prostatektomi (RARP) ameliyatýnda 8 mmHg veya 12 mmHg pnömoperitonum basýnç (PNP) farklýlýklarýnýn operatif, postoperatif ve anesteziyolojik parametreler üzerine etkisinin karþýlaþtýrýlmasý amaçlanmaktadýr.
GEREÇ VE YÖNTEM: Prospektif dizayna sahip çalýþmamýzda, RARP ameliyatýnda deneyimli tek cerrah tarafýndan yapýlan 43 hasta düþük basýnç (8 mmHg - Grup I) veya standart basýnç (12 mmHg - Grup II) gruplarýna PNP'ye göre rastgele randomize edildi. Hastalarýn operatif ve postoperatif parametreleri ürolojik ve anesteziyolojik açýdan deðerlendirildi. Tüm hastalarda AirSeal® insuflasyon sistemi kullanýldý.
BULGULAR: Konsol süresi, tahmini kan kaybý, ilk flatusa kadar geçen süre ve hastanede kalýþ süresi açýsýndan gruplar arasýnda istatistiksel olarak anlamlý bir fark bulunmamýþtýr. PNP, 8 mmHg grubundaki 6 hastada ve 12 mmHg grubundaki 2 hastada kanama nedeniyle 15 mmHg ‘ya geçici süre yükseltildi. Ýlk insizyondan sonra 5. dakikadaki kalp hýzý dýþýnda, kardiak, kan basýncý, ventilasyon ve verilen ilaç parametreleri açýsýndan gruplar arasýnda fark gözlenmemiþtir. Kalp hýzý, Grup I'de anlamlý derecede düþük olarak gözlemlendi (54.4 vs 68.8, p=0.006). Cerrahi sýrasýnda, anestezistler tarafýndan yapýlan müdahalelerin sayýsý (ilaç uygulamalarý, ventilatör yönetimi vb.) Grup I'de anlamlý derecede daha düþük izlendi (6.1 vs 9.6, p=0.041).
SONUÇ: RARP ameliyatýnda 8 mmHg PNP basýncý, 12 mmHg basýnca göre operatif parametrelerde farklýlýk göstermezken, kardiyovasküler ve solunum sistemini tehlikeye atmamak için gereken anestezi müdahalesi gereksiniminin daha az olmasý avantajýna sahiptir.

Anahtar Kelimeler: Airseal® insuflatör sistemi, düþük basýnç pnömoperitonum; intraperitoneal basýnç; intraoperatif sonuçlar; pnömoperitonum basýncý (PNP); robot yardýmlý laparoskopik radikal prostatektomi.

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Anesthesiological and surgical perspectives on using 8 mmHg versus 12 mmHg pneumoperitoneum pressures during robotic radical prostatectomy: Results of a prospective randomized study

Mete Manici¹, Ýbrahim Can Aykanat², Doga Simsek¹, Kayhan Tarim³, Yavuz Gurkan¹, Abdullah Erdem Canda^3
1Department of Anesthesiology, Koc University School of Medicine, Istanbul-Turkiye
²Urology Clinic, Koc University Hospital, Istanbul-Turkiye
³Department of Urology, Koc University School of Medicine, Istanbul-Turkiye

BACKGROUND: This study aims to compare the effects of 8 mmHg and 12 mmHg pneumoperitoneum (PNP) pressures on operative, postoperative, and anesthesiological parameters in robot-assisted laparoscopic radical prostatectomy (RARP).
METHODS: In this prospective study, 43 patients undergoing RARP performed by a single experienced surgeon were randomly assigned to either the low-pressure group (8 mmHg - Group I) or the standard-pressure group (12 mmHg - Group II). We evaluated the operative and postoperative parameters from both urological and anesthesiological perspectives. All patients were treated using the AirSeal® insufflation system.
RESULTS: No statistically significant differences were observed between the groups in terms of console time, estimated blood loss, time to first flatus, or hospital length of stay. PNP was increased due to bleeding in six patients in the 8 mmHg group and two patients in the 12 mmHg group. Except for the heart rate measured five minutes after the initial incision, there were no observed differences between the groups in terms of blood pressure, ventilation, and administered medications. The heart rate was significantly lower in Group I (54.4 vs. 68.8, p=0.006). Additionally, during the surgery, the number of manipulations performed by the anesthesiologists, including drug administrations and ventilator management, was significantly lower in Group I (6.1 vs. 9.6, p=0.041).
CONCLUSION: In RARP, while the 8 mmHg PNP pressure does not demonstrate differences in operative parameters compared to the 12 mmHg pressure, it offers the advantage of requiring fewer anesthetic interventions, thus minimizing the impact on cardiovascular and respiratory systems.

Keywords: Pneumoperitoneum pressure (PNP), low pressure pneumoperitoneum; AirSeal® insufflation system; robot-assisted radical prostatectomy (RARP); intraoperative outcomes; intra-abdominal pressure.

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