Department of Anesthesiology and Reanimation, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Department of Urology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
Turk J Med Sci. 2021 Jun 28;51(3):1136-1145. doi: 10.3906/sag-2005-368.
BACKGROUND/AIM: This study aimed to evaluate the effect of low- and high-pressure pneumoperitoneum pressures applied during robotic-assisted laparoscopic prostatectomy (RALP) using near-infrared spectroscopy (NIRS) on regional cerebral oxygenation saturation (rSO2).
The prospective, comparative, and observational study included patients aged 18–80 years, with the American Society of Anesthesiologists (ASA) physical status I-II, who would undergo elective RALP. The patients were divided into two groups (12 mmHg of pneumoperitoneum pressure group, n=22 and 15 mmHg of pneumoperitoneum pressure group, n=23). Patients’ demographic data, durations of anesthesia, surgery, pneumoperitoneum, and Trendelenburg position, intraoperative estimated blood loss, fluid therapy, urine output, hemodynamic and respiratory data, and rSO2 values were recorded at regular intervals.
The rSO2 values increased significantly during the pneumoperitoneum combined with steep Trendelenburg position (from t3 to t6) and at the end of the surgery (t7) in both groups, compared to the values 5 min after the onset of pneumoperitoneum in the supine position (t2) (P < 0.05), but no statistical significance was observed between the two groups. No cerebral desaturation was observed in any of our patients. Hemodynamic and respiratory parameters were preserved in both groups. The blood lactate levels were significantly higher in patients operated at high-pressure pneumoperitoneum, compared to those with low-pressure pneumoperitoneum (P < 0.05).
We believe that low-pressure pneumoperitoneum, especially in robotic surgeries, such as robotic-assisted laparoscopic prostatectomy (RALP), can be applied safely.
背景/目的：本研究旨在评估在机器人辅助腹腔镜前列腺切除术（RALP）中应用低压和高压气腹压力对局部脑氧饱和度（rSO2）的影响。
这是一项前瞻性、对照、观察性研究，纳入了年龄在 18-80 岁之间、ASA 身体状况 I-II 级、择期接受 RALP 的患者。患者被分为两组（气腹压力为 12mmHg 组，n=22；气腹压力为 15mmHg 组，n=23）。记录患者的人口统计学数据、麻醉持续时间、手术时间、气腹时间、Trendelenburg 体位时间、术中估计失血量、液体治疗、尿量、血流动力学和呼吸数据以及 rSO2 值。
两组患者在气腹联合 steep Trendelenburg 体位（从 t3 到 t6）以及手术结束时（t7）的 rSO2 值均显著升高，与仰卧位气腹 5 分钟后（t2）的 rSO2 值相比（P<0.05），但两组之间无统计学差异。我们的所有患者均未出现脑缺氧。两组患者的血流动力学和呼吸参数均得到维持。高压气腹组的血乳酸水平明显高于低压气腹组（P<0.05）。
我们认为低压气腹，特别是在机器人手术中，如 RALP，可以安全应用。
