ABSTRACT
BACKGROUND: The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. PATIENTS AND METHODS: Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. EXCLUSION CRITERIA: The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. RESULTS: (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well. CONCLUSION: We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.
Subject(s)
Patient Positioning/methods , Pneumoperitoneum, Artificial/methods , Pressure , Prostatectomy/methods , Robotic Surgical Procedures/methods , Aged , Analysis of Variance , Arterial Pressure , Biomarkers/blood , Blood Gas Analysis , Cardiac Output , Head-Down Tilt , Hemodynamics , Humans , Ischemia/etiology , Laparoscopy/methods , Male , Middle Aged , Patient Positioning/adverse effects , Pneumoperitoneum, Artificial/adverse effects , Prostatectomy/adverse effects , Reference Values , Robotic Surgical Procedures/adverse effects , Serum Albumin , Serum Albumin, Human , Splanchnic Circulation , Time FactorsABSTRACT
ABSTRACT Background The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) ...
Subject(s)
Humans , Male , Aged , Pneumoperitoneum, Artificial/methods , Pressure , Prostatectomy/methods , Patient Positioning/methods , Robotic Surgical Procedures/methods , Pneumoperitoneum, Artificial/adverse effects , Prostatectomy/adverse effects , Reference Values , Splanchnic Circulation , Time Factors , Blood Gas Analysis , Serum Albumin , Cardiac Output , Biomarkers/blood , Analysis of Variance , Laparoscopy/methods , Head-Down Tilt , Patient Positioning/adverse effects , Arterial Pressure , Robotic Surgical Procedures/adverse effects , Serum Albumin, Human , Hemodynamics , Ischemia/etiology , Middle AgedABSTRACT
Introduçäo: A criptorquidia é considerada um fator de risco substancial para o desenvolvimento subseqüente do câncer de testículo. Sendo que existe elevada expressäo da p53 nos tumores testiculares, este estudo foi realizado para investigar a expressäo anormal da proteína p53 e as mudanças histológicas num modelo de rato com criptorquidia unilateral. Material e métodos: Ratos pré-puberes foram mecanicamente tornados criptorquídicos unilaterais no 15§ dia após o nascimento. Subseqüentemente, os testículos dos ratos dos grupos experimental e falsamente operados foram removidos após 2, 4 e 6 meses para análises imunohistoquímicas e histológicas. Os testículos contralaterais do grupo experimental serviram de controle. Resultados: Näo foram observadas anormalidades histológicas nos testículos dos grupos falsamente operados e controle. Entretanto, os testículos criptorquídicos apresentaram-se menores e acompanhados de uma mudança de cor acentuada. Foi observada uma diminuiçäo significativa do volume testicular no grupo com criptorquidia (p<0,05). Atrofia dos túbulos seminíferos, espessamento da membrana basal, perda de células germinativas e interrupçäo da espermatogênese foram progressivamente mais evidentes com o tempo, sendo maiores no sexto mês. A coloraçäo imunohistoquímica dos cortes em parafina demonstram reaçäo nuclear positiva à p53 em 14 (93,3 por cento) dos 15 testículos criptorquídicos. Por outro lado, os grupos falsamente operados e controle näo apresentaram qualquer acumulaçäo nuclear p53. Conclusäo: Este estudo confirma que os testículos criptorquídicos intra-abdominais säo significantemente danificados devido à sua localizaçäo anormal. A análise imunohistoquímica positiva para proteína p53 nos testículos criptorquídicos é sugestiva de alteraçäo molecular e pode indicar uma relaçäo entre criptorquidia e carcinogênese testicular.