Chatti C, Corsia G, Yates D-R, Vaessen C, Bitker M-O, Coriat P, Rouprêt M
Service d'anesthésie réanimation, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
Prog Urol. 2011 Nov;21(12):829-34. doi: 10.1016/j.purol.2011.05.004. Epub 2011 Sep 3.
The aim of our work was to present a review of technical features and complications of general anesthesia during robot-assisted laparoscopic radical prostatectomy (RALRP).
Data on RALRP and general anesthesia were explored on Medline using the following MeSH terms: radical prostatectomy; morbidity; anesthesia complications; laparoscopy; robotics; Trendeleburg. Publications were considered on the following criteria: methodology, relevance and date of publication.
There was no data of level of evidence 1 available. The first RALRP was reported in 2000. Technological innovation brought by the robot with its 3-D vision, the acquisition of degrees of mobility and a more ergonomic position for the surgeon, have led to a growing interest from new teams in the western world. However, the RALRP generates constraints for the anesthesia team who need to incorporate the rules of laparoscopy and the patient's specific installation to guarantee maximum safety. There are inherent complications with the installation of the patient himself in the Trendelenburg position (ocular, neurological, hemodynamic, respiratory) and respiratory complications related to the specific procedure in gaseous atmosphere due to pneumoperitoneum. One of the criteria of the quality of publications in the field of surgery is related to the objective evaluation of complications by appropriate scale systems and the complications of general anesthesia must also be absolutely recorded.
RALRP had deeply modified the anatomical landmarks of the surgical removal of prostate cancer. However, the perioperative environment has also been completely altered and the installation of RALRP in the daily routine of a service requires from the anesthesia team to adapt their behavior to this sophisticated surgical access.
我们这项工作的目的是对机器人辅助腹腔镜根治性前列腺切除术（RALRP）期间全身麻醉的技术特点和并发症进行综述。
在Medline上使用以下医学主题词检索有关RALRP和全身麻醉的数据：根治性前列腺切除术；发病率；麻醉并发症；腹腔镜检查；机器人技术；头低脚高位。根据以下标准筛选出版物：方法学、相关性和出版日期。
没有一级证据的数据。首次RALRP报道于2000年。机器人带来的技术创新，如三维视觉、可移动角度的获取以及为外科医生提供更符合人体工程学的体位，引起了西方世界新团队越来越浓厚的兴趣。然而，RALRP给麻醉团队带来了限制，他们需要将腹腔镜检查的规则和患者的特殊体位纳入考虑，以确保最大程度的安全。患者处于头低脚高位本身存在一些内在并发症（眼部、神经、血流动力学、呼吸方面），以及因气腹导致的在气体环境中特定手术相关的呼吸并发症。外科领域出版物质量的标准之一是通过适当的评分系统对并发症进行客观评估，全身麻醉的并发症也必须绝对记录。
RALRP深刻改变了前列腺癌手术切除的解剖标志。然而，围手术期环境也已完全改变，在日常医疗服务中开展RALRP要求麻醉团队调整其行为以适应这种复杂的手术入路。
