1118 DEGREE OF HEAD DOWN ANGLE AT ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AFFECTS CARDIOVASCULAR AND RESPIRATORY PARAMETERS

Abstract

You have accessJournal of UrologyProstate Cancer: Localized V1 Apr 20121118 DEGREE OF HEAD DOWN ANGLE AT ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AFFECTS CARDIOVASCULAR AND RESPIRATORY PARAMETERS Yoshifumi Kadono, Hiroshi Yaegashi, Kazuaki Machioka, Satoru Ueno, Sotaro Miwa, Yuji Maeda, Tohru Miyagi, Atsushi Mizokami, Eitetsu Koh, and Mikio Namiki Yoshifumi KadonoYoshifumi Kadono Kanazawa, Japan More articles by this author , Hiroshi YaegashiHiroshi Yaegashi Kanazawa, Japan More articles by this author , Kazuaki MachiokaKazuaki Machioka Kanazawa, Japan More articles by this author , Satoru UenoSatoru Ueno Kanazawa, Japan More articles by this author , Sotaro MiwaSotaro Miwa Kanazawa, Japan More articles by this author , Yuji MaedaYuji Maeda Kanazawa, Japan More articles by this author , Tohru MiyagiTohru Miyagi Kanazawa, Japan More articles by this author , Atsushi MizokamiAtsushi Mizokami Kanazawa, Japan More articles by this author , Eitetsu KohEitetsu Koh Kanazawa, Japan More articles by this author , and Mikio NamikiMikio Namiki Kanazawa, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1227AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robot-assisted laparoscopic radical prostatectomy (RALP) has been introduced in a treatment of localized prostate cancer because of minimally invasiveness compared to open retropubic radical prostatectomy (RRP). However RALP requires a steep Trendelenburg (head-down) position and a CO2 pneumoperitoneum for several hours to secure the surgical visual field. The aim of this study is to investigate the influence of differences of each angles of Trendelenburg position with pneumoperitoneum during RALP on cardiovascular and respiratory homeostasis. METHODS Twelve patients undergoing open radical prostatectomy and 37 patients undergoing RALP were enrolled in this study. Each patient receiving RALP was placed 20°, 25° or 30° head-down position. Heart Rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2), tidal volume (Vt) and peak inspiratory pressure (PIP) were recorded immediately after anesthesia induction (T0; baseline), 5 minutes after peumoperitoneum in supine position in RALP (T1), 5, 15, 30 and 120 minutes after Trendelenburg position with peumoperitoneum in PALP and 5, 15, 30 and 120minutes after starting operation in open prostatectomy (T2, T3, T4 and T5), 5 minutes after desufflation in supine position in RALP (T6) and at skin closure in supine position (T7). Dynamic compliance (Cdyn) was calculated with the following equation: Cdyn=Vt/(PIP-PEEP). RESULTS There was a significant correlation between angle of head-down tilt and MAP at T2, at T3, at T4, PIP at T2 at T3, at T4, Cdyn at T2, at T3, at T4, at T5. There was no significant correlation between the angle of head-down tilt and HR, RR, PetCO2. MAP gradually decreased over time in each group during Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt become strong, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease, however only Cdyn had significant correlation to angle of head-down tilt between 20° and 30° at T2. CONCLUSIONS This study first demonstrated that the degree of the head down angle at RALP affected the cardiovascular and respiratory parameters. The pneumoperitoneum with head down position in RALP influenced the cardiovascular and respiratory system more than RRP and that these effects were stronger as deeper head down angle. The evaluation of the cardiovascular and respiratory function before RALP is necessary. Shallow head down angle might contribute safe RALP with high risk patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e453 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshifumi Kadono Kanazawa, Japan More articles by this author Hiroshi Yaegashi Kanazawa, Japan More articles by this author Kazuaki Machioka Kanazawa, Japan More articles by this author Satoru Ueno Kanazawa, Japan More articles by this author Sotaro Miwa Kanazawa, Japan More articles by this author Yuji Maeda Kanazawa, Japan More articles by this author Tohru Miyagi Kanazawa, Japan More articles by this author Atsushi Mizokami Kanazawa, Japan More articles by this author Eitetsu Koh Kanazawa, Japan More articles by this author Mikio Namiki Kanazawa, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...