Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
World J Surg Oncol. 2012 Sep 27;10:202. doi: 10.1186/1477-7819-10-202.
Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO₂) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system.
A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO₂), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO₂ insufflation, and 30 min after desufflation.
CO₂ insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients' safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO₂ insufflation pressure caused increases in PaCO₂ and decreases in arterial pH. However, vital signs were stable and pH and PaCO₂ were within the physiologic range during the surgery in the 6- and 9-mmHg groups.
We propose that a CO₂ insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.
目前，在使用达芬奇机器人手术系统进行双侧腋窝入路机器人辅助甲状腺切除术（BABA）时，尚缺乏关于提供清晰手术视野而不引起人体代谢和血液动力学不良变化的安全注气压力的数据。本研究旨在确定各种良性和恶性甲状腺疾病患者在使用达芬奇机器人手术系统时的最佳二氧化碳（CO₂）注气压力。
共有 32 例患者在 6（n = 15）、9（n = 15）和 12（n = 2）mmHg 下接受甲状腺手术。在 CO₂注气后 30 分钟和 1、1.5 和 2 小时以及放气后 30 分钟，测量二氧化碳分压（PaCO₂）、pH 值、心输出量、心率和平均动脉压。
在 BABA 机器人辅助甲状腺切除术中，12mmHg 的 CO₂注气导致严重的面部皮下气肿、高碳酸血症和酸中毒。根据研究方案，为了患者的安全，在研究完成之前停止了该研究。应用 6-或 9mmHg 的 CO₂注气压力会导致 PaCO₂升高和动脉 pH 值降低。然而，在 6-和 9mmHg 组中，生命体征稳定，手术过程中 pH 值和 PaCO₂均在生理范围内。
我们建议在 BABA 机器人辅助甲状腺切除术中，CO₂注气压力低于 10mmHg 是保证患者安全的最佳注气压力。
