Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Division of Minimally Invasive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
J Surg Res. 2024 Oct;302:857-864. doi: 10.1016/j.jss.2024.08.005. Epub 2024 Sep 9.
Although the enhanced-view totally extraperitoneal (eTEP) approach has demonstrated safety, efficacy, and durability for small- to medium-sized hernia repairs, the relationships between retrorectus insufflation, intraoperative respiratory stability, and end-tidal CO (ETCO) levels has not been appraised.
We conducted a retrospective chart review of patients undergoing elective robotic-assisted ventral hernia repairs at our quaternary academic center from July 2018 through December 2021. Patients were grouped by repair technique, either eTEP or robotic transversus abdominis release (r-TAR). Baseline demographics, intraoperative anesthesia records, and perioperative outcomes were reviewed. Anesthesia data were collected at intubation and 30-min time intervals thereafter. Operative time, length of stay, patient-controlled anesthesia use, and perioperative complications were compared.
In total, 205 patients underwent an eTEP repair and 97 patients underwent an r-TAR repair. Intraoperatively, eTEP repairs had significantly higher ETCO at the beginning of the case (times 1-4, P < 0.05), and a higher peak ETCO (P < 0.05) when compared to r-TAR repairs. This difference in ETCO desisted as the case progressed, with a subsequent increase in respiratory rate (times 2-6, P < 0.05) in the eTEP procedures. The eTEP group demonstrated significantly shorter operative times, decreased patient-controlled anesthesia use, and a shorter length of stay. There was no significant difference in postoperative intensive care unit admission or respiratory distress.
This study demonstrates that retrorectus insufflation during eTEP hernia repairs correlated with higher levels of ETCO compared to r-TAR repairs yet was not associated with any meaningful difference in perioperative outcomes. Communication of these respiratory differences with anesthesia is needed for proper ventilation adjustments.
尽管增强型完全腹膜外（eTEP）入路已被证实可安全、有效地治疗中小疝，但尚未评估后腹膜充气与术中呼吸稳定性和呼气末二氧化碳（ETCO）水平之间的关系。
我们对 2018 年 7 月至 2021 年 12 月在我们的四级学术中心接受机器人辅助腹侧疝修补术的患者进行了回顾性图表审查。根据修复技术将患者分为 eTEP 组或机器人横腹肌松解术（r-TAR）组。回顾了基线人口统计学资料、术中麻醉记录和围手术期结果。在插管时和之后的 30 分钟间隔收集麻醉数据。比较手术时间、住院时间、患者自控麻醉的使用和围手术期并发症。
总共有 205 例患者接受了 eTEP 修复，97 例患者接受了 r-TAR 修复。术中，eTEP 修复在手术开始时的 ETCO 明显更高（第 1-4 次，P<0.05），并且 ETCO 峰值更高（P<0.05）与 r-TAR 修复相比。随着手术的进行，这种 ETCO 的差异逐渐消失，eTEP 手术中的呼吸频率也随之增加（第 2-6 次，P<0.05）。eTEP 组的手术时间明显缩短，患者自控麻醉的使用减少，住院时间缩短。术后入住重症监护病房或呼吸窘迫的发生率无显著差异。
本研究表明，与 r-TAR 修复相比，eTEP 疝修复过程中的后腹膜充气与 ETCO 水平升高相关，但与围手术期结果无显著差异。需要与麻醉科沟通这些呼吸差异，以便进行适当的通气调整。
