Airseal During Laparoscopic Radical Prostatectomy and Regional Extended Lymphadenectomy: Intraoperative Advantage

Abstract

Aim: We retrospectively compared two different carbon dioxide insufflators: Thermoflator (standard gas flow rate) and Airseal IFS (continuos bidirectional gas flow, lower flow rate), during laparoscopic radical prostatectomy and extended pelvic lymphadenectomy (t-LRP) in order to detect any differences in the anesthetic respiratory management. Materials and methods: 77 consecutive patients underwent t-LRP. The last 38 patients treated using Thermoflator (group A) have been compared with the first 39 patients treated using Airseal (group B). Mean intrabdominal pressure was mantained at 12 mmHg in all patients. Baseline tidal, minute ventilation and positive end expiratory pressure (PEEP) were set at 8 ml/Kg, 10 breaths/minute and 5 cm H 2 0 respectively in both groups. End-tidal CO 2 and arterial blood gas analysis were monitored during surgery. Changes of the baseline mechanical ventilator parameters have been made in the case of et CO 2 greater than 40 mmHg. Results: Mean introperative et CO 2 was 38.21 mmHg in group A and 39.28 mmHg in group B. Baseline mechanical ventilator paramethers had to be modified in 21/38 group A patients and in 5/39 group B patients (p<0.01). These changes allowed to maintain the et CO2 within 40 mmHg in all patients of both groups. Discussion Laparoscopic urological interventions were always demanding procedures. It was true in most particular way during learning curve. Duration of anaesthesiology time should be taken in account for planning. AirSeal insufflator could be an useful device in order to reduce anesthesiologic implication. Conclusion: In our experience the Airseal system simplified the anesthetic respiratory management and potentially limited the pulmonary damage.