Anesthesia management and patient outcomes in robotic assisted laparoscopic surgery: A single center experience

Abstract

Robotic surgical techniques aimed to improve patient outcomes and satisfy patient outcomes while reducing surgical morbidity and mortality. One of the most performed surgeries, robotic assisted laparoscopic radical prostatectomy (RALRP), is characterized by many factors such as steep Trendelenburg position, and challenging access to the patient. We planned to evaluate anesthesia management and postoperative patient outcomes in RALRP. Patients planned for RALRP between January 2017 and June 2021 were included. Demographic data, additional diseases and Charlson Comorbidity Index (CCI) of the patients were recorded. The methods used in anesthesia maintenance, muscle relaxant and sugammadex dose, postoperative pain treatment protocol, duration of anesthesia and surgery, length of stay (LOS) in ICU or hospital, early postoperative complications and Clavien Dindo Classification (CDC) were evaluated by examining the follow-up forms in the intraoperative and postoperative period. Two hundred and sixteen patients underwent robotic assisted laparoscopic surgery between January 2017 and June 2021 and, 141 of them (65.3%) had RALRP. The mean age of the patients was 62.38±6.94, the body mass index was 27.60±3.94, and the mean CCI was 4.08±0.93. Total intravenous anesthesia (TIVA) (n=108, 76.6%) was mostly used for anesthesia maintenance. The median time spent during anesthesia was 278.5±63.6 minutes. The median time for surgery was 239.5±65.9 minutes. According to the CDC, grade-I was 5.7%, grade-II was 2.1%, grade-IVa 7.8%. The most common complication was acute kidney injury (11, 7.8%), followed by atelectasis (4, 2.8%). 98.6% of all patients were sent to the ward from PACU, except two. The mean LOS in hospital was 4.57±2.34 days. Robotic assisted laparoscopic radical prostatectomy is most performed surgery among all robotic surgeries. We think that, patient optimization and communication between surgeon and anesthesiologist is crucial to avoid the negative effects of steep Trendelenburg position and pneumoperitoneum in terms of improving outcome.