Ramakrishnan Venkat M, Niemann Tilo, Maletzki Philipp, Guenther Edward, Bujaroska Teodora, Labulo Olanrewaju, Li Zhufeng, Slieker Juliette, Kubik-Huch Rahel A, Lehmann Kurt, Nocito Antonio, Hefermehl Lukas J
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Institute of Radiology, Kantonsspital Baden, 5404 Baden, Switzerland.
Diagnostics (Basel). 2022 Mar 23;12(4):785. doi: 10.3390/diagnostics12040785.
Laparoscopic surgery (LS) requires CO insufflation to establish the operative field. Patients with worsening pain post-operatively often undergo computed tomography (CT). CT is highly sensitive in detecting free air-the hallmark sign of a bowel injury. Yet, the clinical significance of free air is often confounded by residual CO and is not usually due to a visceral injury. The aim of this study was to attempt to quantify the residual pneumoperitoneum (RPP) after a robotic-assisted laparoscopic prostatectomy (RALP).
We prospectively enrolled patients who underwent RALP between August 2018 and January 2020. CT scans were performed on postoperative days (POD) 3, 5, and 7. To investigate potential factors influencing the quantity of RPP, correlation plots were made against common variables.
In total, 31 patients with a mean age of 66 years (median 67, IQR 62-70.5) and mean BMI 26.59 (median 25.99, IQR: 24.06-29.24) underwent RALP during the study period. All patients had a relatively unremarkable post-operative course (30/31 with Clavien-Dindo class 0; 1/31 with class 2). After 3, 5, and 7 days, 3.2%, 6.4%, and 32.3% were completely without RPP, respectively. The mean RPP at 3 days was 37.6 mL (median 9.58 mL, max 247 mL, IQR 3.92-31.82 mL), whereas the mean RPP at 5 days was 19.85 mL (median 1.36 mL, max 220.77 mL, IQR 0.19-5.61 mL), and 7 days was 10.08 mL (median 0.09 mL, max 112.42 mL, IQR 0-1.5 mL). There was a significant correlation between RPP and obesity ( = 0.04665), in which higher BMIs resulted in lower initial insufflation volumes and lower RPP.
This is the first study to systematically assess RPP after a standardized laparoscopic procedure using CT. Larger patients tend to have smaller residuals. Our data may help surgeons interpreting post-operative CTs in similar patient populations.
腹腔镜手术（LS）需要注入二氧化碳以建立手术视野。术后疼痛加剧的患者常接受计算机断层扫描（CT）检查。CT在检测游离气体（肠损伤的标志性体征）方面高度敏感。然而，游离气体的临床意义常因残留二氧化碳而混淆，通常并非由内脏损伤所致。本研究的目的是尝试量化机器人辅助腹腔镜前列腺切除术（RALP）后的残余气腹（RPP）。
我们前瞻性纳入了2018年8月至2020年1月期间接受RALP的患者。在术后第3、5和7天进行CT扫描。为了研究影响RPP量的潜在因素，针对常见变量绘制了相关图。
在研究期间，共有31例患者接受了RALP，平均年龄66岁（中位数67岁，四分位间距62 - 70.5岁），平均体重指数（BMI）26.59（中位数25.99，四分位间距24.06 - 29.24）。所有患者术后病程相对平稳（30/31为Clavien-Dindo 0级；1/31为2级）。术后3、5和7天，分别有3.2%、6.4%和32.3%的患者完全没有RPP。术后3天的平均RPP为37.6毫升（中位数9.58毫升，最大值247毫升，四分位间距3.92 - 31.82毫升），而术后5天的平均RPP为19.85毫升（中位数1.36毫升，最大值220.77毫升，四分位间距0.19 - 5.61毫升），术后7天为10.08毫升（中位数0.09毫升，最大值112.42毫升，四分位间距0 - 1.5毫升）。RPP与肥胖之间存在显著相关性（ = 0.04665），即较高的BMI导致初始注入量较低和RPP较低。
这是第一项使用CT系统评估标准化腹腔镜手术后RPP的研究。体型较大的患者往往残余量较小。我们的数据可能有助于外科医生解读类似患者群体的术后CT结果。
