Department of Anesthesia, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, 3755 Côte Ste. Catherine Road, Montreal, QC, H3T 1E2, Canada.
J Robot Surg. 2011 Dec;5(4):235-9. doi: 10.1007/s11701-011-0261-z. Epub 2011 Mar 25.
Robot-assisted gynecologic surgery is performed with a pneumoperitoneum and prolonged maximum Trendelenburg position which can result in adverse physiologic effects. The purpose of this study was to assess the feasibility of robot-assisted gynecologic oncology procedures and to identify anesthesia-related peri-operative adverse events. This is a case series performed on the first 133 patients who underwent a robot-assisted gynecologic oncology procedure at a tertiary care facility. Data was collected from electronically archived patient charts and from a prospective surgical database. Patient demographics were recorded and significant intra-operative and post-operative adverse events were reviewed. Robot-assisted surgery for gynecologic oncologic surgery with the use of extreme Trendelenburg in all patients was safely and successfully performed across a wide range of ages, American Society of Anesthesiologists physical status scores and body mass indices. Although most patients developed various degree of facial edema, only 5% of patients had a delayed extubation. Transient intra-operative hypoxemia (O2 saturation < 90%) occurred in 3.75% (5/133) of patients and hypercapnia (CO2 > 45 mmHg) in 18% (24/133). The mean duration of surgery was 254 min and median hospital stay was 1 day. Anesthetic and peri-operative complications are rare for patients undergoing robot-assisted gynecologic oncology surgeries despite the prolonged use of maximum Trendelenburg positioning and pneumoperitoneum. Although there are new anesthetic challenges, these surgeries were safely performed in a wide range of patients with minimal blood loss, short hospital stay and no significant cardiopulmonary complications.
机器人辅助妇科手术在气腹和长时间最大头低脚高位下进行，这可能导致不良的生理影响。本研究的目的是评估机器人辅助妇科肿瘤手术的可行性，并确定与麻醉相关的围手术期不良事件。这是在一家三级保健机构对前 133 名接受机器人辅助妇科肿瘤手术的患者进行的病例系列研究。数据从电子存档的患者病历和前瞻性手术数据库中收集。记录了患者的人口统计学资料，并审查了重大术中及术后不良事件。在所有患者中，使用极端头低脚高位进行机器人辅助妇科肿瘤手术的安全性和成功率在广泛的年龄、美国麻醉医师协会身体状况评分和体重指数范围内得到了验证。尽管大多数患者出现了不同程度的面部水肿，但只有 5%的患者出现了延迟拔管。术中短暂性低氧血症（O2 饱和度<90%）发生在 3.75%（5/133）的患者中，高碳酸血症（CO2>45mmHg）发生在 18%（24/133）的患者中。手术平均持续时间为 254 分钟，中位住院时间为 1 天。尽管长时间使用最大头低脚高位和气腹，但接受机器人辅助妇科肿瘤手术的患者麻醉和围手术期并发症罕见。尽管存在新的麻醉挑战，但这些手术在广泛的患者中安全进行，出血量少、住院时间短，无明显心肺并发症。
