RESUMO
OBJECTIVES: To compare the effects of CO(2) insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses. MATERIALS AND METHODS: Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO(2) insufflation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two-t-test, with a significance level set at p<0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables. RESULTS: The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO(2) pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it. CONCLUSIONS: This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO(2) reabsorption and risk of acidosis.
Assuntos
Anestesia por Inalação/métodos , Dióxido de Carbono/metabolismo , Hemodinâmica/efeitos dos fármacos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Duração da Cirurgia , Peritônio/cirurgia , Estudos Prospectivos , Neoplasias da Próstata/patologia , Reprodutibilidade dos Testes , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate whether robotically assisted laparoscopic prostatectomy (RALP) is less invasive than radical retropubic prostatectomy (RRP), as experimental studies suggest that the acute phase reaction is proportional to surgery-induced tissue damage. PATIENTS AND METHODS: Between May and November 2006, all patients undergoing RRP or RALP in our department were prospectively assessed. Blood samples were collected 24 h before (T0), during surgery (T1), at the end of anaesthesia (T2), and 12 (T3) and 24 h after surgery (T4), and assayed for interleukin(IL)-6 and IL-1 alpha, C-reactive protein (CRP), and lactate. The Mann-Whitney U-, Student's t- and Friedman tests were used to compare continuous variables, and the Pearson chi-square and Fisher test for categorical variables, with a two-sided P < 0.05 considered to indicate significance. RESULTS: In all, 35 and 26 patients were assessed for RALP and RRP, respectively; the median (interquartile range) age was 62 (56-68) and 68.5 (59.2-71.2) years, respectively (P < 0.009). Baseline levels (T0) of IL-1, IL-6, CRP and lactate were comparable in both arms. IL-6, CRP and lactates levels increased during both kinds of surgery. The mean IL-6 and CPR values were higher for RRP at T1 (P = 0.01 and 0.001), T2 (P = 0.001 and <0.001), T3 (P = 0.002 and <0.001) and T4 (P < 0.001 and 0.02), respectively. Lactate was higher for RRP at T2 (P = 0.001), T3 (P = 0.001) and T4 (P = 0.004), although remaining within the normal ranges. IL-1 alpha did not change at the different sample times. CONCLUSIONS: This study showed for the first time that RALP induces lower tissue trauma than RRP.
Assuntos
Reação de Fase Aguda/prevenção & controle , Laparoscopia , Complicações Pós-Operatórias/prevenção & controle , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Robótica , Idoso , Proteína C-Reativa/análise , Humanos , Interleucina-1alfa/sangue , Interleucina-6/sangue , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/sangue , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
To compare the effects of CO2 insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses.
Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO2 insuffation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two–t-test, with a significance level set at p<0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables.
The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO2 pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it.
This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO2 reabsorption and risk of acidosis.