Vuran Yaz İrem, Bingül Emre Sertaç, Canbaz Mert, Aygün Evren, Şanlı Mehmet Öner, Özcan Faruk, Savran Karadeniz Meltem
Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Millet Cd. Cerrahi Monoblok Giriş Kat, 34093, Fatih, Istanbul, Turkey.
Department of Anesthesiology, Eyupsultan State Hospital, Istanbul, Turkey.
J Robot Surg. 2025 Mar 11;19(1):112. doi: 10.1007/s11701-025-02272-x.
Robotic major abdominal surgeries are popular worldwide, yet very few clinical studies have investigated the effects of robotic surgery setup on respiratory outcomes. In this prospective observational study, it is aimed to demonstrate the change in ultrasonographic condition of the lungs throughout the robotic surgery and its relation with respiratory outcomes. Robotic radical prostatectomy patients without any preexisting lung or cardiac pathology were enrolled in the study. Lung ultrasound score (LUS) was chosen to evaluate lungs perioperatively in three different time points that is as follows: 5 min after intubation (T1), before extubation (T2), and 30 min after extubation (T3). Blood gas analyses were made at the same time points. Primary outcome was the change of LUS comparing T3 versus T1. Secondary outcomes included intraoperative change of LUS, severe postoperative pulmonary complication incidence, unplanned intensive care unit (ICU) admission incidence, comparison of oxygenation via PaO and PaO/FiO, and sensitivity/specificity of LUS for determining ICU admission. Total 48 patients were analyzed. T3 LUS was significantly higher than T1 LUS, and T2 was the highest amongst (15.5 [6, 25] vs 8.5 [4, 20] vs 20.5 [13, 30], respectively, p < 0.01). Pre-extubation LUS were significantly higher in patients who were admitted to ICU comparing who were not (23.5 [17, 30] vs 20 [13, 27], p = 0.03). PaO/FiO ratio did not change among the groups significantly (p = 0.14). ROC curve of T2LUS showed 67% sensitivity and 85% specificity with a cut-off value of 22.5 for ICU admission (AUC 0.73 [0.516, 0.937], p = 0.04). LUS significantly worsened in robotic prostatectomy throughout the surgery, yet clinical deoxygenation or severe PPC were not observed. On the other hand, pre-extubation LUS may be used to determine possible ICU admission for the patients.Clinical trial registry: This study was prospectively registered at Clinicaltrials.gov (NCT05528159).
机器人辅助下的大型腹部手术在全球范围内都很流行，但很少有临床研究探讨机器人手术设置对呼吸结局的影响。在这项前瞻性观察研究中，旨在展示机器人手术全过程中肺部超声状况的变化及其与呼吸结局的关系。本研究纳入了无任何既往肺部或心脏疾病的机器人辅助根治性前列腺切除术患者。选择肺部超声评分（LUS）在三个不同时间点对肺部进行围手术期评估，具体如下：插管后5分钟（T1）、拔管前（T2）和拔管后30分钟（T3）。在相同时间点进行血气分析。主要结局是比较T3与T1时LUS的变化。次要结局包括术中LUS的变化、术后严重肺部并发症发生率、非计划入住重症监护病房（ICU）的发生率、通过PaO和PaO/FiO比较氧合情况，以及LUS对确定ICU入住的敏感性/特异性。共分析了48例患者。T3时的LUS显著高于T1时的LUS，且T2时最高（分别为15.5[6,25]对8.5[4,20]对20.5[13,30]，p<0.01）。入住ICU的患者拔管前LUS显著高于未入住ICU的患者（23.5[17,30]对20[13,27]，p=0.03）。各组间PaO/FiO比值无显著变化（p=0.14）。T2时LUS的ROC曲线显示，对于ICU入住，截断值为22.5时，敏感性为67%，特异性为85%（AUC 0.73[0.516,0.937]，p=0.04）。在机器人前列腺切除术中，LUS在整个手术过程中显著恶化，但未观察到临床脱氧或严重的肺部并发症。另一方面，拔管前的LUS可用于确定患者可能入住ICU的情况。临床试验注册：本研究已在Clinicaltrials.gov（NCT05528159）上进行前瞻性注册。
