Franzini Stefania, Querciagrossa Stefania, Lapenta Cristina, Brebion Myriam, Consonni Dario, Blanc Thomas, Orliaguet Gilles
Department of Pediatric Anesthesia and Intensive Care, Necker-Enfants Malades University Hospital, AP-HP Centre, Université Paris Cité, 149, Rue de Sèvres 75015, Paris, France.
Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Robot Surg. 2025 Jan 4;19(1):42. doi: 10.1007/s11701-024-02198-w.
Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) is the commonest urologic procedure performed in children, entailing retroperitoneal CO2 insufflation and lateral decubitus, whose effects on cardiopulmonary variables are poorly known. We, therefore, studied hemodynamic and respiratory changes due to CO2 insufflation and lateral decubitus in children undergoing R-RALP and their effects on regional tissue oxygenation. Between 1/2021 and 7/2024, children affected by ureteropelvic joint obstruction (UPJO) underwent a pyeloplasty by R-RALP at Necker Enfants Malades Hospital (Paris, France), using a standardized surgical technique and a lung-protecting anesthetic protocol aimed to prevent hypercarbia. Cerebral and renal Near InfraRed Spectroscopy (NIRS) were added to standard monitoring. Mean monitoring parameters and NIRS values were derived from the prospectively kept continuous reading at eight preset points and analyzed. 37 patients were prospectively included (21 males), with a mean age of 6.0 ± 3.9 years, and mean body weight of 22.5 ± 11.3 kg; 15 patients were operated on in Left Lateral Decubitus (LLD) and 22 in Right Lateral Decubitus (RLD). No different LLD/RLD time trends were observed for standard monitoring parameters and NIRS measurements. Conversely, EtCO2 was higher in the RLD group at trocars insertion (T4, + 3.3 mmHg), beginning of CO2 insufflation (T5, + 2.9), and 45 min after the start of the procedure (T6, + 3.1). At the same time points, Pplat was higher in the LLD group at T4 (+ 3.0 cmH2O); T5, (+ 3.4) and T6 (+ 4.7). During R-RALP, the combination of RLD and CO2 insufflation promotes hypercarbia, while LLD requires increasing Pplat pressures, potentially favoring lung injury and hemodynamic instability during prolonged procedures.
腹膜后机器人辅助腹腔镜肾盂成形术（R-RALP）是儿童中最常见的泌尿外科手术，需要进行腹膜后二氧化碳气腹和侧卧位，其对心肺变量的影响尚不清楚。因此，我们研究了接受R-RALP手术的儿童因二氧化碳气腹和侧卧位引起的血流动力学和呼吸变化及其对局部组织氧合的影响。在2021年1月至2024年7月期间，患有输尿管肾盂连接部梗阻（UPJO）的儿童在法国巴黎内克尔儿童医院接受了R-RALP肾盂成形术，采用标准化手术技术和旨在预防高碳酸血症的肺保护麻醉方案。标准监测增加了脑和肾近红外光谱（NIRS）。平均监测参数和NIRS值来自八个预设点的前瞻性连续读数并进行分析。前瞻性纳入37例患者（21例男性），平均年龄6.0±3.9岁，平均体重22.5±11.3 kg；15例患者采用左侧卧位（LLD）手术，22例采用右侧卧位（RLD）手术。对于标准监测参数和NIRS测量，未观察到不同的LLD/RLD时间趋势。相反，在套管插入时（T4，+3.3 mmHg）、二氧化碳气腹开始时（T5，+2.9）和手术开始后45分钟（T6，+3.1），RLD组的EtCO2较高。在相同时间点，LLD组在T4（+3.0 cmH2O）、T5（+3.4）和T6（+4.7）时的平台压较高。在R-RALP手术期间，RLD和二氧化碳气腹的联合作用会促进高碳酸血症，而LLD则需要增加平台压，这可能会在长时间手术期间增加肺损伤和血流动力学不稳定的风险。
