MP26-17 OUTCOMES OF ROBOTIC PROSTATECTOMY PERFORMED AT ULTRALOW PNEUMOPERITONEUM PRESSURE OF 6 MMHG

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2018MP26-17 OUTCOMES OF ROBOTIC PROSTATECTOMY PERFORMED AT ULTRALOW PNEUMOPERITONEUM PRESSURE OF 6 MMHG Matthew Ferroni, Janice Rosenthal, and Ronney Abaza Matthew FerroniMatthew Ferroni More articles by this author , Janice RosenthalJanice Rosenthal More articles by this author , and Ronney AbazaRonney Abaza More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.875AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic prostatectomy (RP) has traditionally been performed at pneumoperitoneal pressures of 12 to 15 mmHg. We hypothesized that using lower pressures could reduce peritoneal stretch and might reduce resultant pain and potentially allow earlier discharge. We instituted a protocol for all RPs decreasing pneumoperitoneum from 15 mmHg to 6 mmHg and began offering patients same-day discharge. We evaluated how often the procedure could be completed at 6 mmHg and whether length of stay could be reduced from our typical overnight stay. METHODS We retrospectively analyzed data from 612 consecutive patients undergoing RP by a single surgeon including 306 at a pneumoperitoneum of 15 mmHg and 306 after changing to 6 mmHg with no exclusions. Bilateral lymphadenectomy was performed in all cases. The AirSeal® System (Conmed) was used as the standard insufflator. We compared pre-operative patient characteristics including body mass index (BMI) and prostate size between groups as well as outcomes, complication rates and 30-day readmissions. RESULTS All 306 consecutive RPs were successfully completed at 6 mmHg and were compared with the preceding consecutive 306 RPs at 15 mmHg. There were no significant differences in BMI (29.4 kg/m2 versus 29.7 kg/m2, p=0.34) or prostate size (52.7 grams versus 53.4 grams, p=0.66) between groups. BMI range was 19.5 to 44.3 kg/m2 in the 6 mmHg group. Mean total operative time was slightly longer at 6 mmHg (154.8 minutes versus 145.6 minutes, p<0.001) and mean estimated blood loss marginally higher (139.3 milliliters versus 118.7 milliliters, p<0.001) compared to 15 mmHg, but there were no blood transfusions in either group. Mean length of stay was shorter for 6 mmHg patients (0.58 days versus 1.01 days, p<0.001) as 41.1% of patients undergoing RP at 6 mmHg were discharged on the day of surgery. The 30-day complication rate among all patients was 6.5% (2.1% Clavien-Dindo grade III-IV) and was 4.2% in the 6 mmHg group (1.3% Clavien-Dindo grade III-IV). Fewer 30-day emergency room visits occurred in 6 mmHg patients (2.9% versus 7.5%, p=0.01) as well as fewer hospital readmissions (1.0% versus 5.6%, p=0.001) as compared to 15 mmHg patients. CONCLUSIONS RP at a pneumoperitoneum of 6 mmHg was uniformly applicable regardless of patient and prostate size without increased complications or transfusions. Same-day discharge was possible in a significant proportion of patients without additional emergency room visits or hospital readmissions. Further study of ultralow pneumoperitoneum including formal assessment of pain scores and impact on renal function is ongoing. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e343-e344 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Matthew Ferroni More articles by this author Janice Rosenthal More articles by this author Ronney Abaza More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...