Anesthesiologic effects of transperitoneal versus extraperitoneal approach during robot-assisted radical prostatectomy: results of a prospective randomized study.
Fabrizio Dal Moro, Alessandro Crestani, Claudio Valotto, Andrea Guttilla, Rodolfo Soncin, Angelo Mangano, Filiberto Zattoni
Author Information
Fabrizio Dal Moro: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
Alessandro Crestani: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
Claudio Valotto: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
Andrea Guttilla: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
Rodolfo Soncin: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
Angelo Mangano: Department of Anesthesiology, Azienda Ospedaliera di Padova, Padova, Italy.
Filiberto Zattoni: Department of Surgical, Oncological and Gastroenterological Sciences Urology, University of Padova, Italy.
OBJECTIVES: To compare the effects of CO(2) insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses. MATERIALS AND METHODS: Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO(2) insufflation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two-t-test, with a significance level set at p<0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables. RESULTS: The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO(2) pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it. CONCLUSIONS: This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO(2) reabsorption and risk of acidosis.
