Central Ohio Urology Group, Columbus, Ohio.
Mount Carmel St. Ann's Hospital Prostate Cancer Program, Columbus, Ohio.
J Urol. 2022 Sep;208(3):626-632. doi: 10.1097/JU.0000000000002729. Epub 2022 May 2.
Laparoscopic and robotic surgery have traditionally been performed with pneumoperitoneum of 12-15 mmHg. Based upon our previous retrospective study showing an advantage to using ultralow pneumoperitoneum during robotic prostatectomy (RP), we performed a randomized, double-blinded, controlled trial of RP at 6 mmHg vs 15 mmHg to assess postoperative pain and opioid use.
Patients undergoing RP with lymphadenectomy by a single surgeon were randomized to pneumoperitoneum pressures of 6 mmHg vs 15 mmHg. Pain scores and opioid use were recorded every 2 hours until discharge. Groups underwent intention-to-treat analysis on the primary outcome of pain scores up to 8 hours after post-anesthesia care unit.
A total of 138 patients were randomized to RP at 6 mmHg or 15 mmHg (67 and 71, respectively). Mean console time was 7 minutes longer at 6 mmHg (135 vs 128 minutes, p=0.02). Mean estimated blood loss was similar (p=0.4) with no transfusions in either group. Most patients were discharged on the same day as surgery (88% vs 84%, p=0.5). There was no statistically significant difference observed in morphine equivalents administered during surgery or used postoperatively, yet 6 mmHg patients had lower immediate (0-4 hours) mean pain scores (2.1 vs 3.5, p <0.01) and lower maximum pain scores (3.0 vs 5.2, p <0.01). Shoulder pain was lower in 6 mmHg patients (0.03 vs 0.15, p=0.01), as was groin pain (0.6 vs 1.2 p=0.01). Patients reported flatus earlier with 6 mmHg (mean 1.0 day vs 1.3 days, p <0.01).
Pneumoperitoneum pressure of 6 mmHg during RP has several advantages over the commonly used level of 15 mmHg without any identified disadvantages. Surgeons should consider using lower insufflation pressures.
腹腔镜和机器人手术传统上采用 12-15mmHg 的气腹压力。基于我们之前的回顾性研究表明在机器人前列腺切除术（RP）中使用超低气腹压力有优势，我们进行了一项随机、双盲、对照试验，比较了 6mmHg 与 15mmHg 气腹压力在 RP 中的应用，以评估术后疼痛和阿片类药物的使用情况。
由同一位外科医生对接受淋巴结清扫术的 RP 患者进行随机分组，气腹压力分别为 6mmHg 和 15mmHg。记录每 2 小时的疼痛评分和阿片类药物使用情况，直到出院。两组均按意向治疗分析主要结局（麻醉后护理单元后 8 小时内的疼痛评分）。
共有 138 例患者被随机分为 6mmHg 或 15mmHg 组（分别为 67 例和 71 例）。6mmHg 组的控制台时间平均延长 7 分钟（135 分钟与 128 分钟，p=0.02）。两组的平均估计失血量相似（p=0.4），均无输血。大多数患者在同一天出院（88%与 84%，p=0.5）。术中或术后使用的吗啡等效物无统计学差异，但 6mmHg 组的即刻（0-4 小时）平均疼痛评分较低（2.1 与 3.5，p<0.01），最大疼痛评分较低（3.0 与 5.2，p<0.01）。6mmHg 组的肩部疼痛较低（0.03 与 0.15，p=0.01），腹股沟疼痛也较低（0.6 与 1.2，p=0.01）。6mmHg 组患者更早排气（平均 1.0 天与 1.3 天，p<0.01）。
RP 中使用 6mmHg 的气腹压力优于常用的 15mmHg 水平，且无任何明显的不利影响。外科医生应考虑使用较低的充气压力。
